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Schmit S, Malshy K, Ochsner A, Golijanin B, Tucci C, Braunagel T, Golijanin D, Pareek G, Hyams E. Lower urinary tract symptoms in elderly men: Considerations for prostate cancer testing. Prostate 2024. [PMID: 39051612 DOI: 10.1002/pros.24772] [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: 02/29/2024] [Revised: 06/24/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE Both lower urinary tract symptoms (LUTS) and prostate cancer (PCa) are common in elderly men. While LUTS are generally due to a benign etiology, they may provoke an evaluation with prostate-specific antigen (PSA), which can lead to a cascade of further testing and possible overdiagnosis in patients with competing risks. There is limited patient and provider understanding of the relationship between LUTS and PCa risk, and a lack of clarity in how to evaluate these men to balance appropriate diagnosis of aggressive PCa with avoidance of overdiagnosis. METHODS A literature review was performed using keywords to query the electronic database PubMed. All articles published before November 2023 were screened by title and abstract for articles relevant to our subject. RESULTS Epidemiological studies suggest that LUTS and PCa are largely independent in elderly men. The best available tools to assess PCa risk include PSA permutations, novel biomarkers, and imaging, but there are limitations in older men based on lack of validation in the elderly and unclear applicability of traditional definitions of "clinically significant" disease. We present a three-tiered approach to evaluating these patients. CONCLUSION Elderly men commonly have LUTS as well as a high likelihood of indolent PCa. A systematic and shared decision-making-based approach can help to balance objectives of appropriate detection of phenotypically dangerous disease and avoidance of over-testing and overdiagnosis.
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Affiliation(s)
- Stephen Schmit
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI, USA, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kamil Malshy
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI, USA, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Anna Ochsner
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI, USA, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Borivoj Golijanin
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI, USA, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christopher Tucci
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI, USA, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Taylor Braunagel
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI, USA, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Dragan Golijanin
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI, USA, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Gyan Pareek
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI, USA, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Elias Hyams
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI, USA, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Valentin B, Arsov C, Ullrich T, Al-Monajjed R, Boschheidgen M, Hadaschik BA, Giganti F, Giessing M, Lopez-Cotarelo C, Esposito I, Antoch G, Albers P, Radtke JP, Schimmöller L. Magnetic Resonance Imaging-guided Active Surveillance Without Annual Rebiopsy in Patients with Grade Group 1 or 2 Prostate Cancer: The Prospective PROMM-AS Study. EUR UROL SUPPL 2024; 59:30-38. [PMID: 38298772 PMCID: PMC10829616 DOI: 10.1016/j.euros.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 02/02/2024] Open
Abstract
Background Multiparametric magnetic resonance imaging (mpMRI) may allow patients with prostate cancer (PC) on active surveillance (AS) to avoid repeat prostate biopsies during monitoring. Objective To assess the ability of mpMRI to reduce guideline-mandated biopsy and to predict grade group upgrading in patients with International Society of Urological Pathology grade group (GG) 1 or GG 2 PC using Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scores. The hypothesis was that the AS disqualification rate (ASDQ) rate could be reduced to 15%. Design setting and participants PROMM-AS was a prospective study assessing 2-yr outcomes for an mpMRI-guided AS protocol. A 12 mo after AS inclusion on the basis of MRI/transrectal ultrasound fusion-guided biopsy (FBx), all patients underwent mpMRI. For patients with stable mpMRI (PRECISE 1-3), repeat biopsy was deferred and follow-up mpMRI was scheduled for 12 mo later. Patients with mpMRI progression (PRECISE 4-5) underwent FBx. At the end of the study, follow-up FBx was indicated for all patients. Outcome measurements and statistical analysis We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for upgrading to GG 2 in the GG 1 group, and to GG 3 in the GG 2 group on MRI. We performed regression analyses that included clinical variables. Results and limitations The study included 101 patients with PC (60 GG 1 and 41 GG 2). Histopathological progression occurred in 31 patients, 18 in the GG 1 group and 13 in the GG 2 group. Thus, the aim of reducing the ASDQ rate to 15% was not achieved. The sensitivity, specificity, PPV, and NPV for PRECISE scoring of MRI were 94%, 64%, 81%, and 88% in the GG 1 group, and 92%, 50%, 92%, and 50%, respectively, in the GG 2 group. On regression analysis, initial prostate-specific antigen (p < 0.001) and higher PRECISE score (4-5; p = 0.005) were significant predictors of histological progression of GG 1 PC. Higher PRECISE score (p = 0.009), initial Prostate Imaging-Reporting and Data System score (p = 0.009), previous negative biopsy (p = 0.02), and percentage Gleason pattern 4 (p = 0.04) were significant predictors of histological progression of GG 2 PC. Limitations include extensive MRI reading experience, the small sample size, and limited follow-up. Conclusions MRI-guided monitoring of patients on AS using PRECISE scores avoided unnecessary follow-up biopsies in 88% of patients with GG 1 PC and predicted upgrading during 2-yr follow-up in both GG 1 and GG 2 PC. Patient summary We investigated whether MRI (magnetic resonance imaging) scores can be used to guide whether patients with lower-risk prostate cancer who are on active surveillance (AS) need to undergo repeat biopsies. Follow-up biopsy was deferred for 1 year for patients with a stable score and performed for patients whose score progressed. After 24 months on AS, all men underwent MRI and biopsy. Among patients with grade group 1 cancer and a stable MRI score, 88% avoided biopsy. For patients with MRI score progression, AS termination was correctly recommended in 81% of grade group 1 and 92% of grade group 2 cases.
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Affiliation(s)
- Birte Valentin
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany
| | - Christian Arsov
- Department of Urology, University of Düsseldorf, Düsseldorf, Germany
- Elisabeth-Krankenhaus Rheydt, Department of Urology and Paediatric Urology, Staedtische Kliniken Moenchengladbach GmbH, Moenchengladbach, Germany
| | - Tim Ullrich
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany
| | | | - Matthias Boschheidgen
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany
| | | | - Francesco Giganti
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Markus Giessing
- Department of Urology, University of Düsseldorf, Düsseldorf, Germany
| | | | - Irene Esposito
- Institute of Pathology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany
| | - Peter Albers
- Department of Urology, University of Düsseldorf, Düsseldorf, Germany
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Jan Philipp Radtke
- Department of Urology, University of Düsseldorf, Düsseldorf, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany
- Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
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Clinical Relevance of Circulating Tumor Cells in Prostate Cancer Management. Biomedicines 2021; 9:biomedicines9091179. [PMID: 34572366 PMCID: PMC8471111 DOI: 10.3390/biomedicines9091179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/29/2021] [Accepted: 09/04/2021] [Indexed: 02/08/2023] Open
Abstract
Given the low specificity of the routinely used biomarker prostate-specific antigen, circulating tumor cell (CTC) enumeration seems to be particularly useful in the monitoring of prostate cancer. In this review, we focused on a few aspects of CTC enumeration in prostate malignancies: prognostic value in metastatic and non-metastatic tumors, role in the monitoring of treatment outcomes, use as a surrogate marker for survival, and other applications, mostly for research purposes. CTC enumeration, without a doubt, offers an attractive perspective in the management of prostate cancer. However, the vast majority of available data about the role of CTC in this malignancy originate from randomized studies of anticancer agents and do not necessarily translate into real-world clinical practice. Further, most studies on the application of CTC in prostate cancer patients were limited to advanced stages of this malignancy. Meanwhile, the role of CTC in the early stages of prostate cancer, in which some patients may present with occult disseminated disease, is still relatively poorly understood, and should thus be studied extensively. Other obstacles in the widespread application of CTC enumeration in routine clinical practice include considerable discrepancies in the number of cells determined with various commercially available systems.
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Chiam K, Carle C, Hughes S, Kench JG, Woo HH, Lord S, Smith DP. Use of multiparametric magnetic resonance imaging (mpMRI) in active surveillance for low-risk prostate cancer: a scoping review on the benefits and harm of mpMRI in different biopsy scenarios. Prostate Cancer Prostatic Dis 2021; 24:662-673. [PMID: 33654249 DOI: 10.1038/s41391-021-00320-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/15/2020] [Accepted: 01/14/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is uncertainty on how multiparametric MRI (mpMRI) and MRI-targeted biopsy (MRI-TB) can be best used to manage low-risk prostate cancer patients on Active Surveillance (AS). We performed a scoping review to evaluate the benefits and harm associated with four different biopsy scenarios in which mpMRI can be implemented in AS. METHODS Medline, Embase and Cochrane Library databases (1 January 2013-18 September 2020) were searched. Included studies were on men with low-risk prostate cancer enrolled in AS, who had mpMRI ± MRI-TB and standard prostate biopsy (systematic transrectal ultrasound or transperineal saturation biopsy), at confirmatory or follow-up biopsy. Primary outcomes were the number of Gleason score upgrades and biopsies avoided. RESULTS Eight confirmatory biopsy studies and three follow-up biopsy studies were included. Compared to the benchmark of using standard biopsy (SB) for all men, the addition of MRI-TB increased the detection of Gleason score upgrades at both confirmatory (6/8 studies) and follow-up biopsy (3/3 studies), with increments of 1.7-11.8 upgrades per 100 men. 6/7 studies suggested that the use of a positive mpMRI to triage men for MRI-TB or SB alone would detect fewer Gleason score upgrades than benchmark at confirmatory biopsy, but the combination of MRI-TB and SB would detect more upgrades than the benchmark. For follow-up biopsy, the evidence on mpMRI triage biopsy scenarios was inconclusive due to the small number of included studies. CONCLUSIONS The addition of MRI-TB to benchmark (SB for all men) maximises the detection of Gleason score upgrades at confirmatory and follow-up biopsy. When the use of mpMRI to triage men for a biopsy is desired, the combination of MRI-TB and SB should be considered for men with positive mpMRI at confirmatory biopsy. The evidence on mpMRI triage scenarios was inconclusive in the follow-up biopsy setting.
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Affiliation(s)
- Karen Chiam
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia. .,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Chelsea Carle
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Suzanne Hughes
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - James G Kench
- Department of Tissue Pathology, Royal Prince Alfred Hospital, NSW Health Pathology, Camperdown, NSW, Australia.,School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, NSW, Australia.,Department of Uro-oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Sally Lord
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.,School of Medicine, University of Notre Dame of Australia, Sydney, NSW, Australia
| | - David P Smith
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Gómez Rivas J, Carrion DM, Chandrasekar T, Álvarez-Maestro M, Enikeev D, Martínez-Piñeiro L, Barret E. The role of multiparametric magnetic resonance imaging in the selection and follow-up of patients undergoing active surveillance for prostate cancer. An European Section of Uro-Technology (ESUT) review. Actas Urol Esp 2021; 45:188-197. [PMID: 33189417 DOI: 10.1016/j.acuro.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION In recent years, active surveillance (AS) has gained popularity as a safe and reasonable option for patients with low-risk, clinically localized prostate cancer. OBJECTIVE To summarize the latest information regarding the use of mpMRI in the setting of active surveillance (AS) for the management of prostate cancer (PCa). EVIDENCE ACQUISITION A PubMed-based, English literature search was conducted through February 2020. We selected the most relevant original articles, meta-analyses and systematic reviews that could provide important information. EVIDENCE SYNTHESIS The great importance of mpMRI of the prostate in the setting of PCa diagnosis is its ability to visualize primarily high-grade cancerous lesions potentially missed on systematic biopsies. In several studies, mpMRI has shown an improved performance over clinically based models for identifying candidates which will benefit the most from AS. Although data on prostate mpMRI during follow-up of men under AS is sparse, it holds the probability to improve significantly AS programs by a more precise selection of optimal candidates, a more accurate identification of disease progression and a reduction in number of biopsies. The goal of reassessment of patients undergoing AS is to find the most effective moment to change attitude to active treatment. CONCLUSION The value of mpMRI has been recognized due to its high negative predictive value (NPV) for lesion upgrading in low-risk PCa patients. The improvement in imaging detection, and precise diagnosis with mpMRI could reduce misclassifications at initial diagnosis and during follow-up, reducing the number of biopsies.
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Affiliation(s)
- J Gómez Rivas
- Departamento de Urología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación para la Salud, Hospital Universitario La Paz (IdiPaz), Madrid, España.
| | - D M Carrion
- Departamento de Urología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación para la Salud, Hospital Universitario La Paz (IdiPaz), Madrid, España
| | - T Chandrasekar
- Departamento de Urología, Hospital Universitario Thomas Jefferson, Filadelfia, EE. UU
| | - M Álvarez-Maestro
- Departamento de Urología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación para la Salud, Hospital Universitario La Paz (IdiPaz), Madrid, España
| | - D Enikeev
- Instituto de Urología y Salud Reproductiva, Universidad Sechenov, Moscú, Rusia
| | - L Martínez-Piñeiro
- Departamento de Urología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación para la Salud, Hospital Universitario La Paz (IdiPaz), Madrid, España
| | - E Barret
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
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Elfatairy KK, Filson CP, Sanda MG, Osunkoya AO, Nour SG. In-Bore MRI-guided Prostate Biopsies in Patients with Prior Positive Transrectal US-guided Biopsy Results: Pathologic Outcomes and Predictors of Missed Cancers. Radiol Imaging Cancer 2020; 2:e190078. [PMID: 33033806 PMCID: PMC7523503 DOI: 10.1148/rycan.2020190078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 04/25/2020] [Accepted: 05/06/2020] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the role of confirmatory in-bore MRI-guided biopsy in patients with low- or intermediate-risk disease diagnosed at prior transrectal US-guided biopsy and to evaluate the rate and predictors for missed cancers. Materials and Methods A retrospective evaluation of 50 consecutive men who had previously undergone transrectal US-guided biopsy with positive results and who underwent subsequent in-bore MRI-guided biopsy at our university hospital (average time interval, 11 months) between 2012 and 2016 was performed. Ten men were excluded because of a history of treatment after transrectal US-guided biopsy. A total of 40 men (mean age, 63 years; range, 47-84 years) were included in this study. Multiparametric 3-T MRI (T2-weighted, diffusion-weighted, and dynamic contrast material-enhanced) and transrectal in-bore MRI-guided biopsy were performed. Cancer detection, disease-grade changes, and cancers missed at in-bore MRI-guided biopsy were evaluated. Descriptive statistics were used to report different rates. The Fisher exact test was used for categoric variables. The Mann-Whitney U test and independent Student t test were used for nonparametric and parametric data, respectively. The McNemar test was used for paired data. Results The overall cancer detection rate when using in-bore MRI-guided biopsy was 65% (26 of 40). In-bore MRI-guided biopsy detected 14 previously undiscovered cancerous lesions (clinically significant cancers [CSCs], 57.1% [eight of 14]). An overall disease upgrade by in-bore MRI-guided biopsy occurred in 40% (16 of 40) of cases (61.5% [16 of 26] of cases with positive results from in-bore MRI-guided biopsy). One case was downgraded from a Gleason score (GS) of 3 + 4 = 7 to a GS of 3 + 3 = 6. Out of 71 sextant biopsies with positive results detected by transrectal US-guided biopsy (from all 40 patients), 80% (57 of 71) were visible on MR images (in-bore MRI-guided biopsy results were positive in 52.6% [30 of 57]), and 20% (14 of 71) had no image correlates on MR images. In-bore MRI-guided biopsy upgraded 60% (18 of 30) and downgraded 3.3% (one of 30) of detected lesions. The false-negative rate was 35% (14.2% [two of 14] of patients had CSCs; GS ≥ 7), was higher in prostate volumes of greater than 40 mL, and was lower in the anterior gland location (P = .04 and .01, respectively). Conclusion Performing confirmatory in-bore MRI-guided biopsy following positive transrectal US-guided biopsy resulted in a high disease-upgrade incidence with subsequently improved disease-risk stratification, particularly when considering patients for active surveillance or focal therapy. Supplemental material is available for this article. © RSNA, 2020See also the commentary by Weiss and Solomon in this issue.
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Affiliation(s)
| | - Christopher P. Filson
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Martin G. Sanda
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Adeboye O. Osunkoya
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Sherif G. Nour
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
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Utilization of Multiparametric MRI of Prostate in Patients under Consideration for or Already in Active Surveillance: Correlation with Imaging Guided Target Biopsy. Diagnostics (Basel) 2020; 10:diagnostics10070441. [PMID: 32610595 PMCID: PMC7400343 DOI: 10.3390/diagnostics10070441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022] Open
Abstract
This study sought to assess the value of multiparametric magnetic resonance image (mp-MRI) in patients with a prostate cancer (PCa) Gleason score of 6 or less under consideration for or already in active surveillance and to determine the rate of upgrading by target biopsy. Three hundred and fifty-four consecutive men with an initial transrectal ultrasound-guided (TRUS) biopsy-confirmed PCa Gleason score of 6 or less under clinical consideration for or already in active surveillance underwent mp-MRI and were retrospectively reviewed. One hundred and nineteen of 354 patients had cancer-suspicious regions (CSRs) at mp-MRI. Each CSR was assigned a Prostate Imaging Reporting and Data System (PI-RADS) score based on PI-RADS v2. One hundred and eight of 119 patients underwent confirmatory imaging-guided biopsy for CSRs. Pathology results including Gleason score (GS) and percentage of specimens positive for PCa were recorded. Associations between PI-RADS scores and findings at target biopsy were evaluated using logistic regression. At target biopsy, 81 of 108 patients had PCa (75%). Among them, 77 patients had upgrading (22%, 77 of 354 patients). One hundred and forty-six CSRs in 108 patients had PI-RADS 3 n = 28, 4 n = 66, and 5 n = 52. The upgraded rate for each category of CSR was for PI-RADS 3 (5 of 28, 18%), 4 (47 of 66, 71%) and 5 (49 of 52, 94%). Using logistic regression analysis, differences in PI-RADS scores from 3 to 5 are significantly associated with the probability of disease upgrade (20%, 73%, and 96% for PI-RADS score of 3, 4, and 5, respectively). Adding mp-MRI to patients under consideration for or already in active surveillance helps to identify undiagnosed PCa of a higher GS or higher volume resulting in upgrading in 22%.
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Röthlin K, Zamboni S, Moschini M, Stucki P, Afferi L, Baumeister P, Mattei A. Multiparametric magnetic resonance imaging ultrasound-guided fusion biopsy during active surveillance: A single-centre study. Arab J Urol 2020; 18:142-147. [PMID: 33029423 PMCID: PMC7473102 DOI: 10.1080/2090598x.2020.1749477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective To analyse the role of multiparametric magnetic resonance imaging (mpMRI) ultrasound (US)-guided fusion biopsy (FB) in patients with low-risk prostate cancer (PCa) under active surveillance (AS). Patients and methods Our retrospective study included 47 patients under AS who consecutively underwent both FB and standard biopsy (SB), from May 2015 until November 2017. We defined FB as a transrectal US-guided biopsy based on mpMRI. The primary endpoint was to assess the rate of concordance between FB and SB in terms of diagnostic yield, as well as the rate of Gleason Score upgrading/downgrading between the two techniques. Cohen’s kappa coefficient (κ) was applied to test the concordance between FB and SB. Results The median (interquartile range [IQR]) follow-up was 20 (13–37) months. The median (IQR) number of cores taken was 13 (12–14) at SB and 4 (4–6) at FB. Overall, FB missed 12/47 (26%) PCa diagnoses compared to SB. There was concordance between SB and FB in 64% of the patients. The κ showed a perfect agreement between SB and FB for the detection of PCa with Gleason Score 4 + 4 and a weak concordance for negative biopsies (κ: 0.46) and for PCa with a Gleason Score 4 + 3 (κ: 0.54). There was Gleason Score upgrading at FB in two of 47 (4%) patients, whereas there was downgrading in three of 47 (6%) patients. Conclusion In our present study, FB showed no superiority over SB for the detection of PCa. On the contrary, FB had a high rate of missed PCa compared to SB. Further studies are required to ascertain the role of FB in AS. Abbreviations AS: active surveillance; FB: fusion biopsy; IL: index lesion; IQR: interquartile range; mpMRI: multiparametric MRI; (cs)PCa: (clinically significant) prostate cancer; PI-RADS: Prostate Imaging-Reporting and Data System; PRIAS: Prostate Cancer Research International Active Surveillance; ROI: region of interest; SB: standard biopsy
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Affiliation(s)
- Kilian Röthlin
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefania Zamboni
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Patrick Stucki
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
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Development and External Validation of Multiparametric MRI-Derived Nomogram to Predict Risk of Pathologic Upgrade in Patients on Active Surveillance for Prostate Cancer. AJR Am J Roentgenol 2020; 214:825-834. [PMID: 31913073 DOI: 10.2214/ajr.19.22196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The aim of this study was to create, develop, and externally validate a nomogram that predicts pathologic upgrade in patients on active surveillance (AS) for prostate cancer using commonly available clinical and multiparametric MRI (mpMRI) factors. MATERIALS AND METHODS. A consecutive sample of 300 patients undergoing AS for prostate cancer at the Keimyung University Dongsan Hospital between 2010 and 2016 was used to develop the nomogram. The validation cohort consisted of 150 patients undergoing active surveillance at Kyungpook National University Hospital between 2013 and 2017. The study outcome was the occurrence of pathologic upgrade in AS patients. The relationship between the clinical and mpMRI factors considered and pathologic upgrade was tested using univariate and multivariate logistic regression analyses. The predictive accuracy of the nomogram was determined using the ROC AUC. RESULTS. The overall rate of pathologic upgrade was 25.0% in the developmental cohort and 22.0% in the validation cohort. Significant variables in the models were age, prostate-specific antigen level, biopsy grade group 2, baseline Prostate Imaging Reporting and Data System (PI-RADS) scores of 4 and 5, positive cores on initial biopsy greater than 1, and biopsy cores with 50% or more tumor involvement. The progression seen on mpMRI of PI-RADS score was significantly associated with pathologic upgrade. The nomogram used to predict the risk of pathologic upgrade had a predictive accuracy of 0.78 in the external validation cohort. CONCLUSION. This study developed and externally validated a nomogram that predicts the risk of pathologic upgrade on the basis of commonly used factors. This nomogram may be used to assist management decision making for patients on AS for prostate cancer.
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Abstract
PURPOSE OF REVIEW To discuss contemporary data on the value of multiparametric MRI (mpMRI) for guiding the decision to biopsy men at risk for prostate cancer, as well as its utility in active surveillance programs. RECENT FINDINGS Although a systematic 12-core biopsy is the current standard of care for men with increased suspicion for prostate cancer, MRI with or without targeted biopsy has been shown to reliably improve the detection of clinically significant disease following a prior negative biopsy. At the same time, there is a growing body of evidence to support the use of MRI for diagnostic purposes in biopsy-naive patients, as well for enrolling and monitoring men on active surveillance programs. SUMMARY mpMRI is an evolving technology with great promise for altering our approach to prostate cancer diagnosis and surveillance. In conjunction with targeted biopsies, MRI offers greater specificity for the detection of clinically significant cancer and therefore may help to reduce overdetection of indolent disease while minimizing the risks and limitations of systematic biopsies.
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Xue W, Huang Y, Li T, Tan P, Liu L, Yang L, Wei Q. Magnetic resonance imaging-guided targeted biopsy in risk classification among patients on active surveillance: A diagnostic meta-analysis. Medicine (Baltimore) 2019; 98:e16122. [PMID: 31261530 PMCID: PMC6617438 DOI: 10.1097/md.0000000000016122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the sensitivity and accuracy of magnetic resonance imaging-guided targeted biopsy (MRI-TB) in patients undergoing active surveillance (AS) procedure. METHODS We searched databases to identify relevant studies which compared MRI-TB with systemic biopsy for diagnosing prostate cancer in patients on AS. Outcomes included sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the curve (AUC) and publication bias of AS group, confirmatory biopsy group and follow-up biopsy group. RESULTS Fourteen articles involving 1693 patients were included. In AS group, the sensitivity was 0.62 (95% confidence interval [CI], 0.57-0.68), specificity was 0.89 (95% CI, 0.87-0.90), NLR was 0.43 (0.31-0.60), PLR was 4.90 (3.50-6.86), DOR was 12.75 (7.22-22.51), and AUC was 0.8645. In confirmatory biopsy group, the sensitivity was 0.67 (0.59-0.74), specificity was 0.89 (0.86-0.91), NLR was 0.42 (0.27-0.65), PLR was 4.94 (3.88-6.30), DOR was 14.54 (9.60-22.02), and AUC was 0.8812. In follow-up biopsy group, the sensitivity was 0.35 (0.22-0.51), specificity was 0.88 (0.82-0.92), NLR was 0.76 (0.52-1.11), PLR was 3.06 (1.71-5.50), DOR was 4.41 (2.15-9.03), and AUC was 0.8367. CONCLUSION MRI-TB has a moderate-to-high diagnostic accuracy for diagnosing and reclassifying patients on AS with high specificity and AUC value under the SROC curve.
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Affiliation(s)
- Wenbin Xue
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Yu Huang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Ping Tan
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Liangren Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
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Hsiang W, Ghabili K, Syed JS, Holder J, Nguyen KA, Suarez-Sarmiento A, Huber S, Leapman MS, Sprenkle PC. Outcomes of Serial Multiparametric Magnetic Resonance Imaging and Subsequent Biopsy in Men with Low-risk Prostate Cancer Managed with Active Surveillance. Eur Urol Focus 2019; 7:47-54. [PMID: 31147263 DOI: 10.1016/j.euf.2019.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/11/2019] [Accepted: 05/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Outcomes of serial multiparametric magnetic resonance imaging (mpMRI) and subsequent biopsy in monitoring prostate cancer (PCa) in men on active surveillance (AS) have not been defined clearly. OBJECTIVE To determine whether changes in serial mpMRI can predict pathological upgrade among men with grade group (GG) 1 PCa managed with AS. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of men with GG1 on AS with at least two consecutive mpMRI examinations during 2012-2018 who underwent mpMRI/ultrasound fusion or systematic biopsies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Progression on serial mpMRI was evaluated as a predictor of pathological upgrading to GG≥2 on a follow-up biopsy using clinical, pathological, and imaging factors in binary logistic regression. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were determined. RESULTS AND LIMITATIONS Of 122 patients, 29 men (23.8%) experienced pathological upgrade on the follow-up biopsy. Progression on mpMRI was not associated with pathological upgrade. The sensitivity, specificity, PPV, and NPV of mpMRI progression for predicting pathological upgrade were 41.3%, 54.8%, 22.2%, and 75%, respectively. Age (odds ratio [OR] 1.17, p=0.006), Prostate Imaging Reporting and Data System (PI-RADS) score on initial mpMRI (4-5 vs ≤3, OR 7.48, p=0.01), number of positive systematic cores (OR 1.84, p=0.03), number of positive targeted cores (OR 0.44, p=0.04), and maximum percent of targeted core tumor involvement (OR 1.04, p=0.01) were significantly associated with pathological upgrade. CONCLUSIONS We did not observe an association between mpMRI progression and pathological upgrade; however, a PI-RADS score of 4-5 on initial mpMRI was predictive of subsequent pathological progression. The continued use of systematic and fusion biopsies appears necessary due to risks of reclassification over time. PATIENT SUMMARY Progression on serial multiparametric magnetic resonance imaging during active surveillance (AS) is not associated with progression on the follow-up biopsy. Both systematic and fusion biopsies are necessary to sufficiently capture progression during AS.
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Affiliation(s)
- Walter Hsiang
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Kamyar Ghabili
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Jamil S Syed
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Justin Holder
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Kevin A Nguyen
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | | | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
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Choi MH, Kim CK, Lee YJ, Jung SE. Prebiopsy Biparametric MRI for Clinically Significant Prostate Cancer Detection With PI-RADS Version 2: A Multicenter Study. AJR Am J Roentgenol 2019; 212:839-846. [DOI: 10.2214/ajr.18.20498] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Cancer Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Young Joon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Eun Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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O’Donohoe RL, Dunne RM, Kimbrell V, Tempany CM. Prostate MRI using an external phased array wearable pelvic coil at 3T: comparison with an endorectal coil. Abdom Radiol (NY) 2019; 44:1062-1069. [PMID: 30324501 DOI: 10.1007/s00261-018-1804-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate T2w and DWI image quality using a wearable pelvic coil (WPC) compared with an endorectal coil (ERC). METHODS Twenty men consecutively presenting to our prostate cancer MRI clinic were prospectively consented to be scanned using a wearable pelvic coil then an endorectal coil and pelvic phased array coil at 3T. Eighteen patients were suitable for inclusion. Axial T2w images were obtained using the WPC and ERC, and DWI images were obtained using the WPC, ERC, and PPA. Analysis was performed in consensus by two readers with experience in prostate MRI. The readers scored the T2w images using six qualitative criteria and the DWI images using five criteria. Signal-to-noise ratio (SNR) was also measured. RESULTS T2w artifact severity was greater for an ERC than a WPC (p = 0.003). There was no significant difference in T2w qualititatve image quality by other measures. The distinction of zonal anatomy on DWI was superior for an ERC compared with both a WPC and a PPA (p = 0.018 and p < 0.001 respectively), and there was no significant difference in DWI image quality by other measures. SNR was significantly higher for ERC imaging for both T2w and DWI. CONCLUSION WPC imaging provides comparable image quality to that of an ERC, potentially reducing the need for an ERC. WPC imaging shows reduced T2w artifact severity and inferior DWI zonal anatomy distinction compared with an ERC. Imaging with a WPC produces a lower SNR than an ERC.
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Cantiello F, Russo GI, Kaufmann S, Cacciamani G, Crocerossa F, Ferro M, De Cobelli O, Artibani W, Cimino S, Morgia G, Damiano R, Nikolaou K, Kröger N, Stenzl A, Bedke J, Kruck S. Role of multiparametric magnetic resonance imaging for patients under active surveillance for prostate cancer: a systematic review with diagnostic meta-analysis. Prostate Cancer Prostatic Dis 2018; 22:206-220. [PMID: 30487646 DOI: 10.1038/s41391-018-0113-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/23/2018] [Accepted: 11/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The use of multiparametric magnetic resonance imaging (mpMRI) in the setting of patients under active surveillance (AS) is promising. In this systematic-review we aimed to analyse the role of mpMRI in patients under AS. METHODS A comprehensive literature research for English-language original and review articles, recently published, was carried out using Medline, Scopus and Web of sciences databases until 30 October 2017. The following MeSH terms were used: 'active surveillance', 'prostate cancer', 'multiparametric magnetic resonance imaging'. A diagnostic meta-analysis was performed for 3.0 T mpMRI in predicting disease re-classification. RESULTS In total, 226 studies were selected after research and after removal of duplicates. After analysis on inclusion criteria, 43 studies were identified as eligible for this systematic review with a total of 6,605 patients. The timing of MRI during follow-up of AS differed from all studies like criteria for inclusion in the AS protocol. Overall, there was a low risk of bias across all studies. The diagnostic meta-analysis for 1.5 tesla showed a sensitivity of 0.60, negative predictive value (NPV) of 0.75 and a hierarchical summary receiving operating curve (HSROC) of 0.74 while for 3.0 tesla mpMRI a sensitivity of 0.81, a NPV of 0.78 and a HSROC of 0.83. CONCLUSIONS Overall, the available evidence suggests that both 1.5 or 3.0 Tesla mpMRI are a valid tool to monitor progression during AS follow-up, showing good accuracy capabilities in detecting PCa re-classification. However, the modality to better define what means 'disease progression' on mpMRI must be further evaluated.
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Affiliation(s)
- Francesco Cantiello
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy.
| | - Sascha Kaufmann
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | | | - Fabio Crocerossa
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | | | - Walter Artibani
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Sebastiano Cimino
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Giuseppe Morgia
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Rocco Damiano
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Konstantin Nikolaou
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Nils Kröger
- Department of Urology, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Arnulf Stenzl
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Jens Bedke
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Stephan Kruck
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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Immediate treatment vs. active-surveillance in very-low-risk prostate cancer: the role of patient-, tumour-, and hospital-related factors. Prostate Cancer Prostatic Dis 2018; 22:337-343. [PMID: 30429595 DOI: 10.1038/s41391-018-0109-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/06/2018] [Accepted: 09/30/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND To provide insight in the treatment variation of very-low-risk prostate cancer patients and to assess the role of hospital-related factors. METHODS All patients diagnosed with very-low-risk prostate cancer (cT1c-cT2a, PSA < 10 ng/ml, Gleason score <7 and <3 positive cores) in 2015 and 2016 were identified through the population-based Netherlands Cancer Registry. Multilevel logistic regression analyses were performed to examine the crude and case-mix adjusted probability of immediate treatment vs. active-surveillance (AS) according to hospital of diagnosis and to evaluate the effect of patient-, tumour-, and hospital-related factors. RESULTS In all, 2047 (85.4%) of the 2396 patients with very-low-risk prostate cancer were managed with AS. The crude proportion of patients with AS varied from 33.3 to 100% between hospitals. Case-mix adjusted probability varied from 71 to 97%. Tumour stage cT2a vs. cT1c (OR 2.0, 95%CI 1.1-3.6), two vs. one positive core (OR 2.8, 95%CI 1.6-4.7), diagnostic MRI (OR 2.8, 95%CI 1.5-5.2), discussion of a patient in a multi-disciplinary team (OR 2.2, 95%CI 1.1-4.5), discussion of treatment options with the patient (OR 3.3, 95%CI 1.5-7.4) and type of hospital (non-university referral hospital vs. community hospital: OR 0.5, 95%CI 0.2-0.9) were associated with immediate treatment. CONCLUSION The majority of Dutch very-low-risk prostate cancer patients is managed with AS but variation between hospitals exists. Part of the variation is explained by patient- and tumour characteristics but also hospital-related factors play a role. This implies that clinical practice could be improved.
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Xu N, Wu YP, Li XD, Lin MY, Zheng QS, Chen SH, Li JF, Wei Y, Xue XY. Risk of upgrading from prostate biopsy to radical prostatectomy pathology: Is magnetic resonance imaging-guided biopsy more accurate? J Cancer 2018; 9:3634-3639. [PMID: 30310522 PMCID: PMC6171015 DOI: 10.7150/jca.26791] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/25/2018] [Indexed: 01/26/2023] Open
Abstract
Background: This study compared magnetic resonance imaging-guided biopsy (MRI-GB) and transrectal ultrasound guided biopsy (TRUS-GB) with the final histology of the radical prostatectomy (RP) specimen. Methods: Our subjects were 229 patients with prostate cancer (PCa), proven histopathologically using MRI-GB or TRUS-GB, who underwent RP at our center between December 2015 and December 2016. The main group included 92 patients who underwent MRI-GB and the control group included 137 patients who underwent 12-core TRUS-GB. Histological findings for RP specimens were compared with those from biopsies. We also evaluated predictors of upgraded Gleason score (GS), using uni- and multivariate analyses. Results: Upgraded GS between biopsy and RP specimen occurred to 22.7% (52/229) of the cohort overall. In univariate analysis, prostate-specific antigen density (PSAD) (P<0.001), prostate volume (PV) < 30 ml (P<0.001), biopsy modality (P=0.027), biopsy GS (P=0.032) and measured MRI lymph node metastasis (P=0.018) were prognostic factors. Multivariate logistic regression analysis showed PV < 30 ml (P<0.001) and biopsy modality (P=0.001) were independent predictors of upgraded GS. Conclusions: MRI-GB may enhance the diagnostic accuracy of prostate cancer detection in final histopathology with lower rate of upgraded GS than TRUS-GB. Also, PV < 30 ml and biopsy modality were independent predictors of upgraded GS.
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Affiliation(s)
- Ning Xu
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Yu-Peng Wu
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Xiao-Dong Li
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Min-Yi Lin
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Qing-Shui Zheng
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Shao-Hao Chen
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Jun-Feng Li
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Yong Wei
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Xue-Yi Xue
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
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Glaser ZA, Porter KK, Thomas JV, Gordetsky JB, Rais-Bahrami S. MRI findings guiding selection of active surveillance for prostate cancer: a review of emerging evidence. Transl Androl Urol 2018; 7:S411-S419. [PMID: 30363494 PMCID: PMC6178314 DOI: 10.21037/tau.2018.03.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Active surveillance (AS) for prostate cancer (PCa) is generally considered to be a safe strategy for men with low-risk, localized disease. However, as many as 1 in 4 patients may be incorrectly classified as AS-eligible using traditional inclusion criteria. The use of multiparametric magnetic resonance imaging (mpMRI) may offer improved risk stratification in both the initial diagnostic and disease monitoring setting. We performed a review of recently published studies to evaluate the utility of this imaging modality for this clinical setting. An English literature search was conducted on PubMed for original investigations on localized PCa, AS, and magnetic resonance imaging. Our Boolean criteria included the following terms: PCa, AS, imaging, MRI, mpMRI, prospective, retrospective, and comparative. Our search excluded publication types such as comments, editorials, guidelines, reviews, or interviews. Our literature review identified 71 original investigations. Among these, 52 met our inclusion criteria. Evidence suggests mpMRI improves characterization of clinically significant prostate cancer (csPCa) foci, and the enhanced detection and risk-stratification afforded by this modality may keep men from being inappropriately placed on AS. Use of serial mpMRI may also permit longer intervals between confirmatory biopsies. Multiple studies demonstrate the benefit of MRI-targeted biopsies. The use of mpMRI of the prostate offers improved confidence in risk-stratification for men with clinically low-risk PCa considering AS. While on AS, serial mpMRI and MRI-targeted biopsy aid in the detection of aggressive disease transformation or foci of clinically-significant cancer undetected on prior biopsy sessions.
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Affiliation(s)
- Zachary A Glaser
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Elkjær MC, Andersen MH, Høyer S, Pedersen BG, Borre M. Prostate cancer: in-bore magnetic resonance guided biopsies at active surveillance inclusion improve selection of patients for active treatment. Acta Radiol 2018; 59:619-626. [PMID: 28747132 DOI: 10.1177/0284185117723372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Active surveillance (AS) of low-risk prostate cancer (PCa) is an accepted alternative to active treatment. However, the conventional diagnostic trans-rectal ultrasound guided biopsies (TRUS-bx) underestimate PCa aggressiveness in almost half of the cases, when compared with the surgical specimen. Purpose To investigate if additional multi-parametric magnetic resonance imaging (mpMRI) of the prostate and MRI-guided in-bore biopsies (MRGB) at AS inclusion would improve selection of patients for active treatment. Material and Methods All patients enrolled in AS programs at two Danish centers, from October 2014 to January 2016, were offered an mpMRI 8-12 weeks after the initial diagnostic TRUS-bx. Candidates had low-risk disease (PSA < 10 ng/mL, <cT2b, Gleason score [GS] < 7). Prostate lesions were scored on the five-point PIRADS scale (version 1 and 2). MRGB were performed on PIRADS 4 or 5 lesions. Significant cancer was defined as GS > 6 or GS 6 (3 + 3) lesions with ≥ 6 mm maximal cancer core length (MCCL). Results A total of 78 patients were included and in 21 patients a total of 22 PIRADS-score 4 or 5 lesions were detected. MRGB pathology revealed that 17 (81%) of these and 22% of the entire AS population harbored significant cancers at AS inclusion. In eight (38%) cases, the GS was upgraded. Also, nine patients (43%) had GS 6 (3 + 3) foci with MCCL ≥ 6 mm. Conclusion In an AS cohort based on TRUS and TRUS-bx diagnostic strategies, supplemental mpMRI and in-bore MRGB were able to efficiently reclassify a substantial number of patients as candidates for immediate active treatment.
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Affiliation(s)
| | | | - Søren Høyer
- Department of Pathology, Aarhus University Hospital, NBG, Denmark
| | | | - Michael Borre
- Department of Urology, Aarhus University Hospital, Skejby, Denmark
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Multiparametric Magnetic Resonance Imaging of the Prostate: Repeatability of Volume and Apparent Diffusion Coefficient Quantification. Invest Radiol 2018; 52:538-546. [PMID: 28463931 PMCID: PMC5544576 DOI: 10.1097/rli.0000000000000382] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the repeatability of a region of interest (ROI) volume and mean apparent diffusion coefficient (ADC) in standard-of-care 3 T multiparametric magnetic resonance imaging (mpMRI) of the prostate obtained with the use of endorectal coil. MATERIALS AND METHODS This prospective study was Health Insurance Portability and Accountability Act compliant, with institutional review board approval and written informed consent. Men with confirmed or suspected treatment-naive prostate cancer scheduled for mpMRI were offered a repeat mpMRI within 2 weeks. Regions of interest corresponding to the whole prostate gland, the entire peripheral zone (PZ), normal PZ, and suspected tumor ROI (tROI) on axial T2-weighted, dynamic contrast-enhanced subtract, and ADC images were annotated and assessed using Prostate Imaging Reporting and Data System (PI-RADS) v2. Repeatability of the ROI volume for each of the analyzed image types and mean ROI ADC was summarized with repeatability coefficient (RC) and RC%. RESULTS A total of 189 subjects were approached to participate in the study. Of 40 patients that gave initial agreement, 15 men underwent 2 mpMRI examinations and completed the study. Peripheral zone tROIs were identified in 11 subjects. Tumor ROI volume was less than 0.5 mL in 8 of 11 subjects. PI-RADS categories were identical between baseline-repeat studies in 11/15 subjects and differed by 1 point in 4/15. Peripheral zone tROI volume RC (RC%) was 233 mm (71%) on axial T2-weighted, 422 mm (112%) on ADC, and 488 mm (119%) on dynamic contrast-enhanced subtract. Apparent diffusion coefficient ROI mean RC (RC%) were 447 × 10 mm/s (42%) in PZ tROI and 471 × 10 mm/s (30%) in normal PZ. Significant difference in repeatability of the tROI volume across series was observed (P < 0.005). The mean ADC RC% was lower than volume RC% for tROI ADC (P < 0.05). CONCLUSIONS PI-RADS v2 overall assessment was highly repeatable. Multiparametric magnetic resonance imaging sequences differ in volume measurement repeatability. The mean tROI ADC is more repeatable compared with tROI volume in ADC. Repeatability of prostate ADC is comparable with that in other abdominal organs.
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Elfatairy KK, Filson CP, Sanda MG, Osunkoya AO, Geller RL, Nour SG. In-bore MRI-guided biopsy: can it optimize the need for periodic biopsies in prostate cancer patients undergoing active surveillance? A pilot test-retest reliability study. Br J Radiol 2018; 91:20170603. [PMID: 29308912 DOI: 10.1259/bjr.20170603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the test-retest reliability of repeated in-bore MRI-guided prostate biopsy (MRGB). METHODS 19 lesions in 7 patients who had consecutive MRGBs were retrospectively analysed. Five patients had 2 consecutive MRGBs and two patients had 3 consecutive MRGBs. Both multiparametric MRI and MRGBs were performed using a 3T MRI scanner. Pathology results were categorized into benign, suspicious and malignant. Consistency between first and subsequent biopsy results were analysed as well as the negative predictive value (NPV) for prostate cancer. RESULTS 15 lesions (≈79%) had matching second biopsy and 4 (21%) had non-matching second biopsy. Lesions with both Prostate Imaging - Reporting and Data System(PIRADS) categories 1 and 4 were all benign and had matching pathology results. Lesions with non-matching results had PIRADS categories 2, 3 and 5. NPV for prostate cancer in first biopsy was 87.5%. Overall agreement was 78.9% and overall disagreement was 21.1%.κ = 0.55 denoting moderate agreement (p = 0.002). 10/19 lesions had a third biopsy session. 9/10 (90%) had matching pathology results across the three biopsy sessions and all matching lesions were benign. CONCLUSION In-bore MRI-guided prostate biopsy may have a better reliability for repeat biopsies compared to TRUS biopsy. Final conclusion awaits a prospective analysis on a larger cohort of patients. Advances in knowledge: This pilot study showed that repeated prostate in-bore MRI-guided prostate biopsy may have better reliability compared to TRUS biopsy with a suggested high NPV.
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Affiliation(s)
- Kareem K Elfatairy
- 1 Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,2 Interventional MRI Program,Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,3 Department of Radiology, Faculty of Medicine, Suez Canal University , Ismailia , Egypt
| | - Christopher P Filson
- 4 Department of Urology, Emory University School of Medicine , Atlanta, GA , United States.,5 Department of Urology, Veterans Affairs Medical Center , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States
| | - Martin G Sanda
- 4 Department of Urology, Emory University School of Medicine , Atlanta, GA , United States.,5 Department of Urology, Veterans Affairs Medical Center , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States
| | - Adeboye O Osunkoya
- 4 Department of Urology, Emory University School of Medicine , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States.,7 Department of Pathology, Emory University School of Medicine , Atlanta, GA United States.,8 Department of Pathology, Veterans Affairs Medical Center , Atlanta, GA , United States
| | - Rachel L Geller
- 7 Department of Pathology, Emory University School of Medicine , Atlanta, GA United States
| | - Sherif G Nour
- 1 Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,2 Interventional MRI Program,Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States
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Value of Serial Multiparametric Magnetic Resonance Imaging and Magnetic Resonance Imaging-guided Biopsies in Men with Low-risk Prostate Cancer on Active Surveillance After 1 Yr Follow-up. Eur Urol Focus 2018; 5:407-415. [PMID: 29331622 DOI: 10.1016/j.euf.2017.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/29/2017] [Accepted: 12/07/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Active surveillance (AS) aims to reduce overtreatment of low-risk prostate cancer (PC). Incorporating multiparametric magnetic resonance imaging (mp-MRI) and MR-guided biopsy (MRGB) in an AS protocol might contribute to more accurate identification of AS candidates. OBJECTIVE To evaluate the value of 3T mp-MRI and MRGB in PC patients on AS at inclusion and after 12-mo follow-up. DESIGN, SETTING, AND PARTICIPANTS Patients with cT1c-cT2 PC, prostate-specific antigen (PSA) ≤10ng/ml, PSA density <0.2ng/ml/ml, and Gleason scores (GSs) of ≤6 and ≤2 positive biopsy cores were included and followed in an AS protocol including mp-MRI and MRGB. The mp-MRI and MRGB were performed at <3 and 12 mo after diagnosis. Reclassification was defined as GS >6, >2 positive cores at repeat transrectal ultrasound-guided biopsy (TRUSGB), presence of PC in >3 separate cancer foci upon both MRGB and TRUSGB, or cT3 tumor on mp-MRI. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Reclassification rates, treatment after discontinuation, and outcome on radical prostatectomy after discontinuing AS were reported. Uni- and multivariate analyses were performed to identify predictors of reclassification after 1 yr. RESULTS AND LIMITATIONS From 2009 to 2013, a total of 111 of 158 patients were consecutively and prospectively included. Around initial diagnosis, 36 patients were excluded from the study protocol; mp-MRI+MRGB reclassified 25/111 (23%) patients, and 11 patients were excluded at own request. Reasons for reclassification were as follows: GS upgrade (15/25, 60%); cT3 disease (3/25, 12%); suspicion of bone metastases (1/25, 4%); and multifocal disease upon MRGB (6/25, 24%). Repeat examinations after 1 yr showed reclassification in 33/75 patients (44%). Reasons were the following: GS upgrade upon TRUSGB (9/33, 27%); volume progression upon TRUSGB (9/33, 27%); cT3 disease upon mp-MRI (1/33, 3%); GS upgrade upon MRGB (1/33, 3%); volume progression upon MRGB (1/33, 3%); multifocal disease upon MRGB (2/33, 6%); and upgrade or upstage upon both TRUSGB and MRGB (10/33, 30%). On logistic regression analysis, the presence of cancer at initial mp-MRI and MRGB examinations was the only predictor of reclassification after 1 yr (odds ratio 5.9, 95% confidence interval 2.0-17.6). CONCLUSIONS Although mp-MRI and MRGB are of additional value in the evaluation of PC patients on AS, the value of mp-MRI after 1 yr was limited. As a considerable percentage of GS ≥7 PC after 1 yr was detected only by TRUSGB, TRUSGB cannot be omitted yet. PATIENT SUMMARY More aggressive tumors are detected if low-risk prostate cancer patients are additionally monitored by magnetic resonance imaging. However, some high-grade tumors are detected only by transrectal ultrasound-guided biopsy.
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Galgano SJ, Glaser ZA, Porter KK, Rais-Bahrami S. Role of Prostate MRI in the Setting of Active Surveillance for Prostate Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:49-67. [DOI: 10.1007/978-3-319-99286-0_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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24
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Bey E, Gaget O, Descotes JL, Franquet Q, Rambeaud JJ, Long JA, Fiard G. Transrectal ultrasound-guided prostate biopsies vs. magnetic resonance imaging ultrasound fusion targeted biopsies: Who are the best candidates? Can Urol Assoc J 2018; 12:E10-E14. [PMID: 29173269 PMCID: PMC5783701 DOI: 10.5489/cuaj.4571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to compare the results of ultrasound-guided prostate biopsies (US-PB) and magnetic resonance imaging-ultrasound fusion biopsies (MRI-PB) in two contemporary cohorts and to describe the parameters orienting the choice of technique. METHODS Two contemporary cohorts of patients undergoing US-PB or MR-PB using the Urostation® (Koelis, Grenoble, France) between November 2010 and July 2015 were analyzed retrospectively. Patients with metastatic cancer or recurrence after treatment, saturation biopsies, and US-PB performed after a negative MRI were excluded. Comparison of populations, biopsy results, and clinical and biological parameters guiding the choice of technique were studied on multivariate analysis (logistic regression) taking into account the following confounding factors: age, prostate-specific antigen (PSA) rate, prostatic volume, number of previous biopsies, and abnormal digital rectal examination. RESULTS One hundred fourteen patients were included in the US-PB group and 118 in the MR-PB group. Prostate cancer was diagnosed among 65 patients in the US-PB group (detection rate 57.0%) and 70 patients in the MR-PB group (detection rate 59.3%) (odds ratio [OR] 3.00; 95% confidence interval [CI] 1.52-6.17; p=0.002). Among the cancers diagnosed in the MR-PB group, 21 were diagnosed by the two targeted biopsy cores only (15.5%). Patients undergoing MR-PB were significantly younger (p=0.0005), with a higher number of previous biopsy sessions (p<10-7) and larger prostate volume (p=0.001). PSA rate alone (p=0.23) and digital rectal examination (p=0.48) did not significantly interfere with the choice of a technique. CONCLUSIONS Younger patients with larger prostates and prior negative biopsy were more likely to be offered the MR-PB technique. On multivariate analysis, the detection rate was higher in the MR-PB group.
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Affiliation(s)
- Elsa Bey
- Department of Urology, Grenoble University Hospital, France
| | - Olivier Gaget
- Department of Public Health, Grenoble University Hospital, France
| | - Jean-Luc Descotes
- Department of Urology, Grenoble University Hospital, France
- CNRS, TIMC-IMAG, France
| | | | - Jean-Jacques Rambeaud
- Department of Urology, Grenoble University Hospital, France
- Université Grenoble Alpes; Grenoble, France
| | - Jean-Alexandre Long
- Department of Urology, Grenoble University Hospital, France
- CNRS, TIMC-IMAG, France
- Université Grenoble Alpes; Grenoble, France
| | - Gaelle Fiard
- Department of Urology, Grenoble University Hospital, France
- CNRS, TIMC-IMAG, France
- Université Grenoble Alpes; Grenoble, France
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25
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Elkjær MC, Andersen MH, Høyer S, Pedersen BG, Borre M. Multi-parametric magnetic resonance imaging monitoring patients in active surveillance for prostate cancer: a prospective cohort study. Scand J Urol 2017; 52:8-13. [PMID: 29212392 DOI: 10.1080/21681805.2017.1409265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the use of multi-parametric magnetic resonance imaging (mpMRI) and mpMRI guided biopsies (MRGB) for monitoring an active surveillance (AS) prostate cancer cohort. MATERIALS AND METHODS One year after initial diagnostic TRUS guided biopsy (TRUS-bx), baseline mpMRI, and enrolment in an AS program patients underwent a one year follow-up comprising the usual TRUS-bx and an mpMRI. Prostate MRI lesions were scored on the five-point PIRADS scale version 2. In cases without TRUS-bx progression, patients with PIRADS 4 or 5 lesions were scheduled for MRGB. Progression in TRUS-bx was defined as Gleason score (Gs) up-grades, >3 tumor positive cores or a maximal cancer core length (MCCL) > 50%. In MRGB, Gs upgrade or a MCCL ≥6 mm Gs 3 + 3 lesions were considered to reflect progression. PSA increase or progression in clinical T-classification alone was not considered clinical progression. RESULTS 50 patients were included in the study. In total 10 (20%) patients had per definition progression at one year follow-up. Seven patients (7/50 = 14%) had clinical progression based on TRUS-bx. mpMRI identified seven newly emerged PIRADS 4 lesions. Three patients with PIRADS 4 lesions had no sign of TRUS-bx progression, while MRGB revealed significant cancer (Gs 7 (3 + 4) and Gs 8 (3 + 5)). Consequently, seven patients underwent definitive treatment. Of these, six and four had a progression on MRI and TRUS-bx, respectively. CONCLUSIONS Our study suggests that mpMRI is at least equal to TRUS-bx in detecting progression at one year follow-up in prostate cancer patients undergoing active surveillance.
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Affiliation(s)
| | | | - Søren Høyer
- c Department of Pathology , Aarhus University Hospital , NBG , Denmark
| | | | - Michael Borre
- a Department of Urology , Aarhus University Hospital , Skejby , Denmark
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26
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Bjurlin MA, Taneja SS. Prediagnostic Risk Assessment with Prostate MRI and MRI-Targeted Biopsy. Urol Clin North Am 2017; 44:535-546. [DOI: 10.1016/j.ucl.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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27
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Glaser ZA, Gordetsky JB, Porter KK, Varambally S, Rais-Bahrami S. Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance. Front Oncol 2017; 7:256. [PMID: 29164056 PMCID: PMC5670116 DOI: 10.3389/fonc.2017.00256] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/12/2017] [Indexed: 01/04/2023] Open
Abstract
Background Active surveillance (AS) is a widely adopted strategy to monitor men with low-risk, localized prostate cancer (PCa). Current AS inclusion criteria may misclassify as many as one in four patients. The advent of multiparametric magnetic resonance imaging (mpMRI) and novel PCa biomarkers may offer improved risk stratification. We performed a review of recently published literature to characterize emerging evidence in support of these novel modalities. Methods An English literature search was conducted on PubMed for available original investigations on localized PCa, AS, imaging, and biomarkers published within the past 3 years. Our Boolean criteria included the following terms: PCa, AS, imaging, biomarker, genetic, genomic, prospective, retrospective, and comparative. The bibliographies and diagnostic modalities of the identified studies were used to expand our search. Results Our review identified 222 original studies. Our expanded search yielded 244 studies. Among these, 70 met our inclusion criteria. Evidence suggests mpMRI offers improved detection of clinically significant PCa, and MRI-fusion technology enhances the sensitivity of surveillance biopsies. Multiple studies demonstrate the promise of commercially available screening assays for prediction of AS failure, and several novel biomarkers show promise in this setting. Conclusion In the era of AS for men with low-risk PCa, improved strategies for proper stratification are needed. mpMRI has dramatically enhanced the detection of clinically significant PCa. The advent of novel biomarkers for prediction of aggressive disease and AS failure has shown some initial promise, but further validation is warranted.
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Affiliation(s)
- Zachary A Glaser
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
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Verma S, Choyke PL, Eberhardt SC, Oto A, Tempany CM, Turkbey B, Rosenkrantz AB. The Current State of MR Imaging-targeted Biopsy Techniques for Detection of Prostate Cancer. Radiology 2017; 285:343-356. [PMID: 29045233 DOI: 10.1148/radiol.2017161684] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Systematic transrectal ultrasonography (US)-guided biopsy is the standard approach for histopathologic diagnosis of prostate cancer. However, this technique has multiple limitations because of its inability to accurately visualize and target prostate lesions. Multiparametric magnetic resonance (MR) imaging of the prostate is more reliably able to localize significant prostate cancer. Targeted prostate biopsy by using MR imaging may thus help to reduce false-negative results and improve risk assessment. Several commercial devices are now available for targeted prostate biopsy, including in-gantry MR imaging-targeted biopsy and real-time transrectal US-MR imaging fusion biopsy systems. This article reviews the current status of MR imaging-targeted biopsy platforms, including technical considerations, as well as advantages and challenges of each technique. © RSNA, 2017.
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Affiliation(s)
- Sadhna Verma
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Peter L Choyke
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Steven C Eberhardt
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Aytekin Oto
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Clare M Tempany
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Baris Turkbey
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Andrew B Rosenkrantz
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
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Chang YCC, Ackerstaff E, Tschudi Y, Jimenez B, Foltz W, Fisher C, Lilge L, Cho H, Carlin S, Gillies RJ, Balagurunathan Y, Yechieli RL, Subhawong T, Turkbey B, Pollack A, Stoyanova R. Delineation of Tumor Habitats based on Dynamic Contrast Enhanced MRI. Sci Rep 2017; 7:9746. [PMID: 28851989 PMCID: PMC5575347 DOI: 10.1038/s41598-017-09932-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/01/2017] [Indexed: 02/03/2023] Open
Abstract
Tumor heterogeneity can be elucidated by mapping subregions of the lesion with differential imaging characteristics, called habitats. Dynamic Contrast Enhanced (DCE-)MRI can depict the tumor microenvironments by identifying areas with variable perfusion and vascular permeability, since individual tumor habitats vary in the rate and magnitude of the contrast uptake and washout. Of particular interest is identifying areas of hypoxia, characterized by inadequate perfusion and hyper-permeable vasculature. An automatic procedure for delineation of tumor habitats from DCE-MRI was developed as a two-part process involving: (1) statistical testing in order to determine the number of the underlying habitats; and (2) an unsupervised pattern recognition technique to recover the temporal contrast patterns and locations of the associated habitats. The technique is examined on simulated data and DCE-MRI, obtained from prostate and brain pre-clinical cancer models, as well as clinical data from sarcoma and prostate cancer patients. The procedure successfully identified habitats previously associated with well-perfused, hypoxic and/or necrotic tumor compartments. Given the association of tumor hypoxia with more aggressive tumor phenotypes, the obtained in vivo information could impact management of cancer patients considerably.
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Affiliation(s)
| | - Ellen Ackerstaff
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Yohann Tschudi
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Bryan Jimenez
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Warren Foltz
- STTARR Innovation Centre, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Carl Fisher
- Department of Medical Biophysics, University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lothar Lilge
- Department of Medical Biophysics, University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - HyungJoon Cho
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Sean Carlin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Robert J Gillies
- Cancer Imaging and Metabolism, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | | | - Raphael L Yechieli
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ty Subhawong
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
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30
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Tran GN, Leapman MS, Nguyen HG, Cowan JE, Shinohara K, Westphalen AC, Carroll PR. Magnetic Resonance Imaging–Ultrasound Fusion Biopsy During Prostate Cancer Active Surveillance. Eur Urol 2017; 72:275-281. [DOI: 10.1016/j.eururo.2016.08.023] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/08/2016] [Indexed: 12/31/2022]
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31
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Chen N, Rong M, Shao X, Zhang H, Liu S, Dong B, Xue W, Wang T, Li T, Pan J. Surface-enhanced Raman spectroscopy of serum accurately detects prostate cancer in patients with prostate-specific antigen levels of 4-10 ng/mL. Int J Nanomedicine 2017; 12:5399-5407. [PMID: 28794631 PMCID: PMC5538684 DOI: 10.2147/ijn.s137756] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The surface-enhanced Raman spectroscopy (SERS) of blood serum was investigated to differentiate between prostate cancer (PCa) and benign prostatic hyperplasia (BPH) in males with a prostate-specific antigen level of 4-10 ng/mL, so as to reduce unnecessary biopsies. A total of 240 SERS spectra from blood serum were acquired from 40 PCa subjects and 40 BPH subjects who had all received prostate biopsies and were given a pathological diagnosis. Multivariate statistical techniques, including principal component analysis (PCA) and linear discriminant analysis (LDA) diagnostic algorithms, were used to analyze the spectra data of serum from patients in control (CTR), PCa and BPH groups; results offered a sensitivity of 97.5%, a specificity of 100.0%, a precision of 100.0% and an accuracy of 99.2% for CTR; a sensitivity of 90.0%, a specificity of 97.5%, a precision of 94.7% and an accuracy of 98.3% for BPH; a sensitivity of 95.0%, a specificity of 93.8%, a precision of 88.4% and an accuracy of 94.2% for PCa. Similarly, this technique can significantly differentiate low- and high-risk PCa with an accuracy of 92.3%, a specificity of 95% and a sensitivity of 89.5%. The results suggest that analyzing blood serum using SERS combined with PCA-LDA diagnostic algorithms is a promising clinical tool for PCa diagnosis and assessment.
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Affiliation(s)
- Na Chen
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, School of Communication and Information Engineering, Shanghai University
| | - Ming Rong
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, School of Communication and Information Engineering, Shanghai University
| | - Xiaoguang Shao
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai
| | - Heng Zhang
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, School of Communication and Information Engineering, Shanghai University
| | - Shupeng Liu
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, School of Communication and Information Engineering, Shanghai University.,Beijing Advanced Innovation Center for Imaging Technology, Capital Normal University, Beijing, People's Republic of China
| | - Baijun Dong
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai
| | - Wei Xue
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai
| | - Tingyun Wang
- Key Laboratory of Specialty Fiber Optics and Optical Access Networks, School of Communication and Information Engineering, Shanghai University
| | - Taihao Li
- Beijing Advanced Innovation Center for Imaging Technology, Capital Normal University, Beijing, People's Republic of China
| | - Jiahua Pan
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai
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PI-RADS Version 2: Detection of Clinically Significant Cancer in Patients With Biopsy Gleason Score 6 Prostate Cancer. AJR Am J Roentgenol 2017; 209:W1-W9. [DOI: 10.2214/ajr.16.16981] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Johnson DC, Reiter RE. Multi-parametric magnetic resonance imaging as a management decision tool. Transl Androl Urol 2017; 6:472-482. [PMID: 28725589 PMCID: PMC5503956 DOI: 10.21037/tau.2017.05.22] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The ability to image the prostate accurately and better characterize cancerous lesions makes multiparametric magnetic resonance imaging (mpMRI) an invaluable tool to improve management of localized prostate cancer (PCa). Improved risk stratification is warranted given the evidence of significant overtreatment of indolent PCa. mpMRI can more accurately rule out clinically significant PCa in men deciding between surveillance and definitive treatment to reduce overtreatment. mpMRI improves detection of clinically significant PCa, which helps minimize sampling error, a major limitation of the traditional diagnostic paradigm. Aside from helping determine candidacy for initial surveillance vs. treatment, mpMRI is a useful tool for following men on active surveillance (AS) with the potential to reduce the need for serial biopsies. When definitive treatment is warranted, mpMRI can be used to determine the local extent of disease. This provides information that is useful in the treatment decision, counseling about outcomes, and surgical planning. While mpMRI is a significant step forward in PCa management, it is necessary to understand its limitations. mpMRI and MRI-guided fusion biopsy techniques still do not detect all clinically significant tumors. The utility of current mpMRI techniques is limited by the multifocal nature of PCa with poor detection of non-index lesions, inaccurate estimation of tumor size and geometry, and the need for interpretation by specialized radiologists. The role of mpMRI will continue to expand as improvements in technology and experience help overcome these limitations.
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Affiliation(s)
- David C Johnson
- Department of Urology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Institute of Urologic Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert E Reiter
- Department of Urology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Institute of Urologic Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Molecular Biology Institute, Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Ma TM, Tosoian JJ, Schaeffer EM, Landis P, Wolf S, Macura KJ, Epstein JI, Mamawala M, Carter HB. The Role of Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Biopsy in Active Surveillance. Eur Urol 2017; 71:174-180. [DOI: 10.1016/j.eururo.2016.05.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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Barrett T, Haider MA. The Emerging Role of MRI in Prostate Cancer Active Surveillance and Ongoing Challenges. AJR Am J Roentgenol 2017; 208:131-139. [PMID: 27726415 DOI: 10.2214/ajr.16.16355] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Active surveillance (AS) has emerged as a management strategy for preventing overtreatment of indolent prostate cancer. Selection of patients for AS has traditionally proved challenging and resulted in 20-30% misclassification rates. MRI has potential to help overcome this limitation, broaden selection criteria to increase recruitment, and minimize the invasive nature of AS follow-up. CONCLUSION The main issues surrounding MRI and AS are the heterogeneity of inclusion criteria, the definition of significant disease, and agreement about what constitutes radiologic progression. Prospective cohorts with MRI at enrollment and long-term follow-up are required to further address these issues.
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Affiliation(s)
- Tristan Barrett
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Masoom A Haider
- 2 Department of Medical Imaging, Sunnybrook Health Sciences Center and University of Toronto, Toronto, ON, Canada
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Comparison of image quality and patient discomfort in prostate MRI: pelvic phased array coil vs. endorectal coil. Abdom Radiol (NY) 2016; 41:2218-2226. [PMID: 27369051 DOI: 10.1007/s00261-016-0819-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare image quality (IQ) and patient discomfort during prostate MRI using a pelvic phased array (PPA) coil and an endorectal (ER) coil. MATERIALS AND METHODS Ninety-eight patients (median age, 65.7; range 42.1-78.1) underwent prostate MRI on a 3T scanner including T2w and DWI acquired with PPA and an ER coil within the same exam. Acquisition time was kept similar for both acquisitions. Two radiologists evaluated aspects of IQ on a 5-point Likert scale and classified image artifacts. All patients completed a questionnaire on discomfort/pain regarding the ER coil using a visual analogue scale from 1 to 10. RESULTS There was no significant difference in overall IQ for T2w images for both readers (reader 1, 3.27 ± 0.91 and 3.07 ± 0.84, p = 0.057; reader 2, 3.70 ± 0.75 and 3.77 ± 0.81, p = 0.555) for PPA and ER coils, respectively. Overall IQ for DWI acquired with PPA and ER coils was rated similar by reader 1 (3.03 ± 1.10 and 3.08 ± 0.80, respectively, (p = 0.67)), while reader 2 preferred ER coil images (3.27 ± 0.81 and 3.66 ± 0.85 (p < 0.05)). Susceptibility artifacts were more frequent in ER than in PPA coil images (109 vs. 75). Discomfort and pain experienced during insertion of the ER coil was low altogether (VAS score, 3.5 ± 2.1 for "discomfort" and 2.4 ± 2.4 for "pain"). CONCLUSION T2-weighted images may be acquired with comparable IQ using a PPA coil as compared to an ER coil, while DWI images showed better IQ using the ER coil for one of two readers. The insertion of the ER coil caused low to moderate discomfort and pain in patients.
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Holtz JN, Tay KJ, Polascik TJ, Gupta RT. Integration of multiparametric MRI into active surveillance of prostate cancer. Future Oncol 2016; 12:2513-2529. [DOI: 10.2217/fon-2016-0142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Prostate cancer is the most common noncutaneous cancer in men though many men will not die of this disease and may not require definitive treatment. Active surveillance (AS) is an increasingly utilized potential solution to the issue of overtreatment of prostate cancer. Traditionally, prostate cancer patients have been stratified into risk groups based on clinical stage on digital rectal examination, prostate-specific antigen and biopsy Gleason score, though each of these variables has significant limitations. This review will discuss the potential role for prostate multiparametric MRI and targeted biopsy techniques incorporating MRI in the selection of candidates for AS, monitoring patients on AS and as triggers for definitive treatment.
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Affiliation(s)
- Jamie N Holtz
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
| | - Kae Jack Tay
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
| | - Thomas J Polascik
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
| | - Rajan T Gupta
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
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Rosenkrantz AB, Babb JS, Taneja SS, Ream JM. Proposed Adjustments to PI-RADS Version 2 Decision Rules: Impact on Prostate Cancer Detection. Radiology 2016; 283:119-129. [PMID: 27783538 DOI: 10.1148/radiol.2016161124] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To test the impact of existing Prostate Imaging Reporting and Data System (PI-RADS) version 2 (V2) decision rules, as well as of proposed adjustments to these decision rules, on detection of Gleason score (GS) 7 or greater (GS ≥7) prostate cancer. Materials and Methods Two radiologists independently provided PI-RADS V2 scores for the dominant lesion on 343 prostate magnetic resonance (MR) examinations. Diagnostic performance for GS ≥7 tumor was assessed by using MR imaging-ultrasonography fusion-targeted biopsy as the reference. The impact of existing PI-RADS V2 decision rules, as well as a series of exploratory proposed adjustments, on the frequency of GS ≥7 tumor detection, was evaluated. Results A total of 210 lesions were benign, 43 were GS 6, and 90 were GS ≥7. Lesions were GS ≥7 in 0%-4.1% of PI-RADS categories 1 and 2, 11.4%-27.1% of PI-RADS category 3, 44.4%-49.3% of PI-RADS category 4, and 72.1%-73.7% of PI-RADS category 5 lesions. PI-RADS category 4 or greater had sensitivity of 78.9%-87.8% and specificity of 75.5%-79.1 for detecting GS ≥7 tumor. The frequency of GS ≥7 tumor for existing PI-RADS V2 decision rules was 30.0%-33.3% in peripheral zone (PZ) lesions upgraded from category 3 to 4 based on dynamic contrast enhancement (DCE) score of positive; 50.0%-66.7% in transition zone (TZ) lesions upgraded from category 3 to 4 based on diffusion-weighted imaging (DWI) score of 5; and 71.7%-72.7% of lesions in both zones upgraded from category 4 to 5 based on size of 15 mm or greater. The frequency of GS ≥7 tumor for proposed adjustments to the decision rules was 30.0%-60.0% for TZ lesions upgraded from category 3 to 4 based on DWI score of 4; 33.3%-57.1% for TZ lesions upgraded from category 3 to 4 based on DCE score of positive when incorporating new criteria (unencapsulated sheetlike enhancement) for DCE score of positive in TZ; and 56.4%-61.9% for lesions in both zones upgraded from category 4 to 5 based on size of 10-14 mm. Other proposed adjustments yielded GS ≥7 tumor in less than 15% of cases for one or more readers. Conclusion Existing PI-RADS V2 decision rules exhibited reasonable performance in detecting GS ≥7 tumor. Several proposed adjustments to the criteria (in TZ, upgrading category 3 to 4 based on DWI score of 4 or modified DCE score of positive; in PZ or TZ, upgrading category 4 to 5 based on size of 10-14 mm) may also have value for this purpose. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Andrew B Rosenkrantz
- From the Department of Radiology, Center for Biomedical Imaging (A.B.R., J.S.B., J.M.R.), and Department of Urology, Division of Urologic Oncology (S.S.T.), NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Floor, New York, NY 10016
| | - James S Babb
- From the Department of Radiology, Center for Biomedical Imaging (A.B.R., J.S.B., J.M.R.), and Department of Urology, Division of Urologic Oncology (S.S.T.), NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Floor, New York, NY 10016
| | - Samir S Taneja
- From the Department of Radiology, Center for Biomedical Imaging (A.B.R., J.S.B., J.M.R.), and Department of Urology, Division of Urologic Oncology (S.S.T.), NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Floor, New York, NY 10016
| | - Justin M Ream
- From the Department of Radiology, Center for Biomedical Imaging (A.B.R., J.S.B., J.M.R.), and Department of Urology, Division of Urologic Oncology (S.S.T.), NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Floor, New York, NY 10016
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Hashimoto T, Rahul K, Takeda T, Benfante N, Mulhall JP, Hricak H, Eastham JA, Vargas HA. Prostate magnetic resonance imaging findings in patients treated for testosterone deficiency while on active surveillance for low-risk prostate cancer. Urol Oncol 2016; 34:530.e9-530.e14. [PMID: 27665357 DOI: 10.1016/j.urolonc.2016.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/30/2016] [Accepted: 07/08/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the multiparametric prostate magnetic resonance imaging (mpMRI) findings in patients treated with testosterone replacement therapy (TRT) while on active surveillance for low-risk prostate cancer. METHODS We retrospectively reviewed 12 patients who underwent mpMRI before and after TRT while on active surveillance. Changes in serum testosterone level, prostate-specific antigen (PSA), prostate biopsy findings, prostate volume, and Prostate Imaging Reporting and Data System Version 2 (PI-RADSv2) score before and after TRT were summarized. RESULTS After TRT, there was a significant increase in serum testosterone (516.5ng/dl vs. 203.0ng/dl), PSA (4.2ng/ml vs. 3.3ng/ml), and prostate volume (55.2cm3 vs. 39.4cm3). In total, 2 patients had biopsy progression during the study period. The PI-RADSv2 scores before and after TRT were unchanged in 10/12 patients; none of these demonstrated biopsy progression on post-TRT. The PI-RADSv2 scores increased after TRT in 2/12 patients; both showed Gleason score upgrade on follow-up biopsy. Of these 2 patients, 1 patient underwent radical treatment due to clinical progression. The area under the curve for detecting biopsy progression calculated from PI-RADSv2 score after TRT was 0.90, which was better than that calculated from post-TRT PSA level (0.48). CONCLUSIONS After TRT, mpMRI findings remained stable in patients without biopsy progression, whereas PI-RADSv2 score increase was identified in patients with Gleason score upgrade on follow-up biopsy.
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Affiliation(s)
- Takeshi Hashimoto
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Urology, Tokyo Medical University, Tokyo, Japan
| | - Krishnan Rahul
- Sexual and Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer, New York, NY
| | - Toshikazu Takeda
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicole Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John P Mulhall
- Sexual and Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer, New York, NY
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Pessoa RR, Viana PC, Mattedi RL, Guglielmetti GB, Cordeiro MD, Coelho RF, Nahas WC, Srougi M. Value of 3-Tesla multiparametric magnetic resonance imaging and targeted biopsy for improved risk stratification in patients considered for active surveillance. BJU Int 2016; 119:535-542. [DOI: 10.1111/bju.13624] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Rodrigo R. Pessoa
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Publio C. Viana
- Department of Diagnostic and Interventional Radiology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Romulo L. Mattedi
- Department of Pathology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Giuliano B. Guglielmetti
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Mauricio D. Cordeiro
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Rafael F. Coelho
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - William C. Nahas
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Miguel Srougi
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
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Leyh-Bannurah SR, Abou-Haidar H, Dell'Oglio P, Schiffmann J, Tian Z, Heinzer H, Huland H, Graefen M, Budäus L, Karakiewicz PI. Primary Gleason pattern upgrading in contemporary patients with D'Amico low-risk prostate cancer: implications for future biomarkers and imaging modalities. BJU Int 2016; 119:692-699. [PMID: 27367469 DOI: 10.1111/bju.13570] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To retrospectively assess the rate of high-grade primary Gleason upgrading (HGPGU) to primary Gleason pattern 4 or 5 in a contemporary cohort of patients with D'Amico low-risk prostate cancer including those who fulfilled Prostate Cancer Research International Active Surveillance (PRIAS) criteria, and to develop a tool for HGPGU prediction. HGPGU is a contraindication in most active surveillance (AS) and focal therapy protocols. PATIENTS AND METHODS In all, 10 616 patients with localised prostate cancer were treated at a high-volume European tertiary care centre from 2010 to 2015 with radical prostatectomy. Analyses were restricted to 1 819 patients with D'Amico low-risk prostate cancer (17.1%) with prostate-specific antigen (PSA) levels of <10.0 ng/mL, cT1c-cT2a and Gleason score ≤6, and were repeated within 772 of the men (7.3%) who fulfilled the PRIAS criteria for AS (PSA level of ≤10 ng/mL, T1c-T2, Gleason score ≤6, PSA density (PSAD) of <0.2 ng/mL2 , ≤2 positive cores). Uni- and multivariable logistic regression models were fitted, testing predictors of HGPGU. The final logistic regression model was based on the most informative variables. RESULTS There was HGPGU in 88 (4.8%) patients with D'Amico low-risk prostate cancer and in 32 (4.1%) of the subgroup who were PRIAS eligible. Multivariable analysis predicting HGPGU for the patients with D'Amico low-risk yielded three independent predictors: age, PSAD, and clinical tumour stage (P = 0.008, P = 0.005 and P = 0.021, respectively). Within the same patients, the model using all vs the most informative variables resulted in area under the curves (AUCs) of 69.2% and 68.3%, respectively. Multivariable analysis of those who were PRIAS eligible, yielded age and number of positive cores as independent predictors of HGPGU (P = 0.002 and P = 0.049, respectively; AUC 64.9%). CONCLUSIONS The low accuracy (invariably <70%) for HGPGU prediction in both patients with D'Amico low-risk prostate cancer and PRIAS eligibility indicates that these variables have poor predictive ability in contemporary patients. Despite HGPGU being a rare phenomenon, it may have life threatening implications and consequently alternatives such as biomarkers, genetic markers, or imaging modalities at re-biopsy are needed.
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Affiliation(s)
- Sami-Ramzi Leyh-Bannurah
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hiba Abou-Haidar
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Department of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Paolo Dell'Oglio
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jonas Schiffmann
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Hans Heinzer
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Budäus
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Department of Urology, University of Montreal Health Center, Montreal, QC, Canada
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Pepe P, Garufi A, Priolo G, Pennisi M. Transperineal Versus Transrectal MRI/TRUS Fusion Targeted Biopsy: Detection Rate of Clinically Significant Prostate Cancer. Clin Genitourin Cancer 2016; 15:e33-e36. [PMID: 27530436 DOI: 10.1016/j.clgc.2016.07.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/10/2016] [Accepted: 07/13/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To evaluate the detection rate for clinically significant prostate cancer (PCa) of transperineal (TP) versus transrectal (TR) multiparametric (mp) magnetic resonance imaging (MRI)/transrectal ultrasound-guided (TRUS) fusion targeted biopsy. PATIENTS AND METHODS From January 2015 to January 2016, a total of 200 men (median age, 61 years) with negative digital rectal examination findings underwent repeat saturation TP prostate biopsy (SPBx; median 30 cores) for increasing or persistent elevated prostate-specific antigen values. Ten day before SPBx, all patients underwent 3.0 T pelvic mpMRI (Achieva 3T; Philips Healthcare Best, Netherlands). In the presence of mpMRI lesions suggestive of cancer (Prostate Imaging-Reporting and Data System [PI-RADS] score 4/5), targeted mpMRI/TRUS TR fusion guided biopsies (4 cores) and TP cognitive biopsies (4 cores) were added to SPBx. RESULTS Median prostate-specific antigen was 8.6 ng/mL, and mpMRI revealed a suspicious lesion in 95 (47.5%) of 200 cases. Overall, in 60 (30%) of 200 men, a clinically significant PCa was found, and in all cases, mpMRI was positive. SPBx, TR fusion, and mpMRI/TRUS TP cognitive targeted biopsy diagnosed 59 (98.3%), 40 (78.3%), and 56 (93.3%) clinically significant PCa, respectively. TR fusion versus TP targeted biopsy missed 12 versus 1 (P = .001) cancers of the anterior zone and 8 versus 3 (P = .12) cancers of the peripheric gland, respectively; moreover, PCa diagnosed by TR fusion versus TP targeted biopsy had a mpMRI lesion diameter and percentage of positive cores equal to 13 versus 10 mm and 33% versus 58% (P = .001), respectively. CONCLUSION mpMRI/TRUS TP cognitive targeted biopsy found a greater percentage of clinically significant PCa of the anterior zone compared to the mpMRI/TRUS TR fusion approach (93.3% vs. 25%; P = .0001).
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Affiliation(s)
- Pietro Pepe
- Urology Unit, Cannizzaro Hospital, Catania, Italy.
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Park SY, Jung DC, Oh YT, Cho NH, Choi YD, Rha KH, Hong SJ, Han K. Prostate Cancer: PI-RADS Version 2 Helps Preoperatively Predict Clinically Significant Cancers. Radiology 2016; 280:108-16. [DOI: 10.1148/radiol.16151133] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Bokhorst LP, Valdagni R, Rannikko A, Kakehi Y, Pickles T, Bangma CH, Roobol MJ. A Decade of Active Surveillance in the PRIAS Study: An Update and Evaluation of the Criteria Used to Recommend a Switch to Active Treatment. Eur Urol 2016; 70:954-960. [PMID: 27329565 DOI: 10.1016/j.eururo.2016.06.007] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/07/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Prostate Cancer Research International Active Surveillance (PRIAS) study was initiated a decade ago to study the most optimal selection and follow-up of men on active surveillance (AS). OBJECTIVE We report on 10 yr of follow-up of men on AS in the PRIAS study and evaluate if criteria used to recommend a switch to active treatment truly predict unfavorable outcome on subsequent radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS Men with low-risk prostate cancer were included and followed prospectively on AS. Follow-up consisted of regular prostate-specific antigen (PSA) tests, digital rectal examinations, and biopsies. Men with Gleason >3+3, more than two positive biopsy cores, or stage higher than cT2 were advised to switch to active treatment (until 2014, a PSA doubling time [PSA DT] of 0-3 yr was also used). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Reclassification rates, treatment after discontinuation, and outcome on RP after discontinuing AS were reported. Regression analysis on the outcome of RP was used to evaluate the predictive value of criteria currently used to recommend a switch to active treatment. Kaplan-Meier and competing risk analysis were used to report discontinuation rates over time and long-term oncologic end points. RESULTS AND LIMITATIONS A total of 5302 men were included in PRIAS across 18 countries. Reclassification rates remained stable on all subsequent biopsies, with 22-33% of men having either Gleason >3+3 or more than two positive cores on any repeat biopsy. At 5 and 10 yr of follow-up, 52% and 73% of men, respectively, had discontinued AS, most of them because of protocol-based reclassification. A third of men undergoing subsequent RP had favorable pathologic tumor features (Gleason 3+3 and pT2). Of the criteria used to recommend a switch to active treatment, more than two positive cores and a PSA DT of 0-3 yr were not predictive of unfavorable pathologic outcome on RP. CONCLUSIONS A substantial group of men discontinued AS without subsequent unfavorable tumor features on RP; therefore, we propose Gleason upgrading and cT3 as the only indicators for an immediate switch to active treatment. Surrogate indicators (eg, more than two positive cores and a fast-rising PSA) should not trigger immediate active treatment but rather further investigation to confirm the suspicion of higher risk disease. PATIENT SUMMARY We confirmed the safety of active surveillance as a treatment option for men with low-risk prostate cancer; however, some changes could be made to the follow-up protocol to safely increase the number of men who remain on active surveillance.
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Affiliation(s)
- Leonard P Bokhorst
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Riccardo Valdagni
- Prostate Cancer Program and Radiation Oncology 1, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antti Rannikko
- Department of Urology, Helsinki University Central Hospital, Helsinki, Finland
| | - Yoshiyuki Kakehi
- Department of Urology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Tom Pickles
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Use of a Quality Improvement Initiative to Achieve Consistent Reporting of Level of Suspicion for Tumor on Multiparametric Prostate MRI. AJR Am J Roentgenol 2016; 206:1040-4. [PMID: 27105339 DOI: 10.2214/ajr.15.15768] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this article is to evaluate the utility of a quality improvement (QI) initiative in achieving long-term adherence to an evolving structured format for reporting the level of suspicion for tumor on prostate MRI examinations. MATERIALS AND METHODS The original QI initiative occurred over a 4-month period in 2010, before which prostate MRI was reported using free text. The initiative consisted of development of a section-wide macro, an initial group training session, ordering physician input regarding the structured report's value, subsequent weekly sessions for ongoing review, and timely individualized feedback in instances of nonuse. The initial structured report included pick lists for describing the level of suspicion for tumor as negative, low, medium, or high. Pick lists were modified in 2011 to incorporate a 5-point Likert scale and again in 2015 to incorporate Prostate Imaging Data and Reporting System (PI-RADS) version 2. These refinements were implemented after accelerated training periods. The frequency of reports providing an MRI-based suspicion level during these periods was assessed. RESULTS Fifty-five percent of reports provided an MRI-based level of suspicion for tumor before the initiative. For various cohorts evaluated after the initiative (using structured reports based on the low, medium, or high scheme; a numeric Likert scale; or PI-RADS), this frequency improved to 95-100% (p < 0.001). Among reports without a suspicion level, potential confounding factors included marked artifact from hip prosthesis and overt diffuse tumor. CONCLUSION The QI initiative achieved excellent adherence in reporting a suspicion level for tumor on prostate MRI examinations. The described components of the initiative were useful for maintaining long-term adherence that persisted after serial modifications to the report lexicon.
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Chong JJ, Van Hemelrijck M, Cahill D, Kinsella J. Serial transperineal sector prostate biopsies: impact on long-term erectile dysfunction. Ecancermedicalscience 2016; 10:643. [PMID: 27350788 PMCID: PMC4898939 DOI: 10.3332/ecancer.2016.643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Indexed: 11/24/2022] Open
Abstract
We wanted to determine whether serial transperineal sector prostate biopsies have a long-term effect on erectile dysfunction (ED). A total of 64 men with prostate cancer entered our active surveillance (AS) programme after a transrectal prostate biopsy as well as a confirmatory initial transperineal sector prostate biopsy (TPSBx). A repeat TPSBx was performed 24 months later as part of our active surveillance protocol. The International Index of Erectile Function-5 (IIEF-5) questionnaire assessed ED at baseline prior to each TPSBx, and at one, three, and six months after first and second TPSBx. There was a significant short-term deterioration in erectile function on mean IIEF-5 score between baseline (19.5), when compared to one month (10.5) (P <0.001) and three months (18.7) (P = 0.001) following first TPSBx. This resolved at six month follow-up (19.6) (P = 0.681). Following second TPSBx, there was a deterioration in erectile function between baseline (16.6), compared to one month (7.3), three months (13.8), and six months (15.9) (P <0.05) following second TPSBx. Initial TPSBx caused significant short-term ED, which resolved by six months. Serial TPSBx appears to have an adverse impact on erectile function in men monitored on AS, increasing the risk of long-term ED. This risk should be highlighted and discussed during the consent process.
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Affiliation(s)
- James Jy Chong
- Faculty of Life Sciences and Medicine, King's College London, London SE1 1UL, UK
| | - Mieke Van Hemelrijck
- Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, King's College London, London SE1 9RT, UK
| | - Declan Cahill
- Department of Urology, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Janette Kinsella
- Department of Urology, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
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In-bore magnetic resonance-guided transrectal biopsy for the detection of clinically significant prostate cancer. Abdom Radiol (NY) 2016; 41:954-62. [PMID: 27118268 DOI: 10.1007/s00261-016-0750-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine the safety and efficacy of in-bore magnetic resonance-guided prostate biopsy (MRGB) for detection of clinically significant disease (CSD) in untreated men with known or suspected prostate cancer (PCa). METHODS 512 patients underwent multiparametric magnetic resonance imaging (Mp-MRI) followed by MRGB at one of three centers in this IRB-approved, HIPAA-compliant, retrospective study. Exclusion criteria were prior prostate cancer therapy and incomplete Mp-MRI (n = 51). Patients (n = 461) were analyzed in two subcohorts: no prior PCa (NP) (n = 381) and active surveillance (AS) (n = 80). Detection rates of PCa and CSD (Gleason Score ≥3 + 4) were calculated and compared among subcohorts and by Mp-MRI assessment grade. Logistic regression was performed to identify predictors for detection of PCa and CSD. RESULTS Mean patient age was 66 years, median prostate-specific antigen (PSA) was 7.5 ng/mL, and median prostate volume was 54 cc. A mean of 1.7 targets was sampled per gland. Significant adverse events (urosepsis and hematuria with obstruction) occurred in 1% (5/461). Overall PCa detection rates were 51% per patient (233/461) and 37% per lesion (282/757). 65% (151/233) of men with detected PCa had CSD. Per-patient PCa detection rates in the NP and AS subcohorts were 47% (178/381) and 69% (55/80), respectively, significantly higher in the AS group (p < 0.001). CSD was detected in 10% (47/451), 43% (96/225) and 84% (68/81) of lesions with Mp-MRI assessment grades of 3, 4, and 5, respectively. Older age, higher PSA, and lower prostate volume predicted MRGB detection of CSD (OR 1.07 and p = 0.003, OR 1.1 and p = 0.014, and OR 0.98 and p = 0.032, respectively). CONCLUSIONS In-bore MRGB is safe and high yield for detection of CSD.
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Rosenkrantz AB, Ginocchio LA, Cornfeld D, Froemming AT, Gupta RT, Turkbey B, Westphalen AC, Babb JS, Margolis DJ. Interobserver Reproducibility of the PI-RADS Version 2 Lexicon: A Multicenter Study of Six Experienced Prostate Radiologists. Radiology 2016; 280:793-804. [PMID: 27035179 DOI: 10.1148/radiol.2016152542] [Citation(s) in RCA: 354] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose To determine the interobserver reproducibility of the Prostate Imaging Reporting and Data System (PI-RADS) version 2 lexicon. Materials and Methods This retrospective HIPAA-compliant study was institutional review board-approved. Six radiologists from six separate institutions, all experienced in prostate magnetic resonance (MR) imaging, assessed prostate MR imaging examinations performed at a single center by using the PI-RADS lexicon. Readers were provided screen captures that denoted the location of one specific lesion per case. Analysis entailed two sessions (40 and 80 examinations per session) and an intersession training period for individualized feedback and group discussion. Percent agreement (fraction of pairwise reader combinations with concordant readings) was compared between sessions. κ coefficients were computed. Results No substantial difference in interobserver agreement was observed between sessions, and the sessions were subsequently pooled. Agreement for PI-RADS score of 4 or greater was 0.593 in peripheral zone (PZ) and 0.509 in transition zone (TZ). In PZ, reproducibility was moderate to substantial for features related to diffusion-weighted imaging (κ = 0.535-0.619); fair to moderate for features related to dynamic contrast material-enhanced (DCE) imaging (κ = 0.266-0.439); and fair for definite extraprostatic extension on T2-weighted images (κ = 0.289). In TZ, reproducibility for features related to lesion texture and margins on T2-weighted images ranged from 0.136 (moderately hypointense) to 0.529 (encapsulation). Among 63 lesions that underwent targeted biopsy, classification as PI-RADS score of 4 or greater by a majority of readers yielded tumor with a Gleason score of 3+4 or greater in 45.9% (17 of 37), without missing any tumor with a Gleason score of 3+4 or greater. Conclusion Experienced radiologists achieved moderate reproducibility for PI-RADS version 2, and neither required nor benefitted from a training session. Agreement tended to be better in PZ than TZ, although was weak for DCE in PZ. The findings may help guide future PI-RADS lexicon updates. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Andrew B Rosenkrantz
- From the Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016 (A.B.R., L.A.G., J.S.B.); Department of Radiology, Yale School of Medicine, New Haven, Conn (D.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.); Department of Radiology, Duke University Medical Center, Duke Cancer Institute, Durham, NC (R.T.G.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Departments of Radiology and Biomedical Imaging and Urology, University of California-San Francisco, San Francisco, Calif (A.C.W.); and Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.J.M.)
| | - Luke A Ginocchio
- From the Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016 (A.B.R., L.A.G., J.S.B.); Department of Radiology, Yale School of Medicine, New Haven, Conn (D.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.); Department of Radiology, Duke University Medical Center, Duke Cancer Institute, Durham, NC (R.T.G.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Departments of Radiology and Biomedical Imaging and Urology, University of California-San Francisco, San Francisco, Calif (A.C.W.); and Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.J.M.)
| | - Daniel Cornfeld
- From the Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016 (A.B.R., L.A.G., J.S.B.); Department of Radiology, Yale School of Medicine, New Haven, Conn (D.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.); Department of Radiology, Duke University Medical Center, Duke Cancer Institute, Durham, NC (R.T.G.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Departments of Radiology and Biomedical Imaging and Urology, University of California-San Francisco, San Francisco, Calif (A.C.W.); and Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.J.M.)
| | - Adam T Froemming
- From the Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016 (A.B.R., L.A.G., J.S.B.); Department of Radiology, Yale School of Medicine, New Haven, Conn (D.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.); Department of Radiology, Duke University Medical Center, Duke Cancer Institute, Durham, NC (R.T.G.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Departments of Radiology and Biomedical Imaging and Urology, University of California-San Francisco, San Francisco, Calif (A.C.W.); and Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.J.M.)
| | - Rajan T Gupta
- From the Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016 (A.B.R., L.A.G., J.S.B.); Department of Radiology, Yale School of Medicine, New Haven, Conn (D.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.); Department of Radiology, Duke University Medical Center, Duke Cancer Institute, Durham, NC (R.T.G.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Departments of Radiology and Biomedical Imaging and Urology, University of California-San Francisco, San Francisco, Calif (A.C.W.); and Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.J.M.)
| | - Baris Turkbey
- From the Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016 (A.B.R., L.A.G., J.S.B.); Department of Radiology, Yale School of Medicine, New Haven, Conn (D.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.); Department of Radiology, Duke University Medical Center, Duke Cancer Institute, Durham, NC (R.T.G.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Departments of Radiology and Biomedical Imaging and Urology, University of California-San Francisco, San Francisco, Calif (A.C.W.); and Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.J.M.)
| | - Antonio C Westphalen
- From the Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016 (A.B.R., L.A.G., J.S.B.); Department of Radiology, Yale School of Medicine, New Haven, Conn (D.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.); Department of Radiology, Duke University Medical Center, Duke Cancer Institute, Durham, NC (R.T.G.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Departments of Radiology and Biomedical Imaging and Urology, University of California-San Francisco, San Francisco, Calif (A.C.W.); and Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.J.M.)
| | - James S Babb
- From the Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016 (A.B.R., L.A.G., J.S.B.); Department of Radiology, Yale School of Medicine, New Haven, Conn (D.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.); Department of Radiology, Duke University Medical Center, Duke Cancer Institute, Durham, NC (R.T.G.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Departments of Radiology and Biomedical Imaging and Urology, University of California-San Francisco, San Francisco, Calif (A.C.W.); and Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.J.M.)
| | - Daniel J Margolis
- From the Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016 (A.B.R., L.A.G., J.S.B.); Department of Radiology, Yale School of Medicine, New Haven, Conn (D.C.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.); Department of Radiology, Duke University Medical Center, Duke Cancer Institute, Durham, NC (R.T.G.); Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.T.); Departments of Radiology and Biomedical Imaging and Urology, University of California-San Francisco, San Francisco, Calif (A.C.W.); and Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.J.M.)
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MRI-Guided In-Bore Biopsy: Differences Between Prostate Cancer Detection and Localization in Primary and Secondary Biopsy Settings. AJR Am J Roentgenol 2016; 206:92-9. [DOI: 10.2214/ajr.15.14579] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Romero-Otero J, García-Gómez B, Duarte-Ojeda JM, Rodríguez-Antolín A, Vilaseca A, Carlsson SV, Touijer KA. Active surveillance for prostate cancer. Int J Urol 2015; 23:211-8. [PMID: 26621054 DOI: 10.1111/iju.13016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/20/2015] [Indexed: 12/20/2022]
Abstract
It is worth distinguishing between the two strategies of expectant management for prostate cancer. Watchful waiting entails administering non-curative androgen deprivation therapy to patients on development of symptomatic progression, whereas active surveillance entails delivering curative treatment on signs of disease progression. The objectives of the two management strategies and the patients enrolled in either are different: (i) to review the role of active surveillance as a management strategy for patients with low-risk prostate cancer; and (ii) review the benefits and pitfalls of active surveillance. We carried out a systematic review of active surveillance for prostate cancer in the literature using the National Center for Biotechnology Information's electronic database, PubMed. We carried out a search in English using the terms: active surveillance, prostate cancer, watchful waiting and conservative management. Selected studies were required to have a comprehensive description of the demographic and disease characteristics of the patients at the time of diagnosis, inclusion criteria for surveillance, and a protocol for the patients' follow up. Review articles were included, but not multiple papers from the same datasets. Active surveillance appears to reduce overtreatment in patients with low-risk prostate cancer without compromising cancer-specific survival at 10 years. Therefore, active surveillance is an option for select patients who want to avoid the side-effects inherent to the different types of immediate treatment. However, inclusion criteria for active surveillance and the most appropriate method of monitoring patients on active surveillance have not yet been standardized.
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Affiliation(s)
| | | | | | | | - Antoni Vilaseca
- Urology Department, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Sigrid V Carlsson
- Urology Department, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karim A Touijer
- Urology Department, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
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