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Shimizu R, Morizane S, Yamamoto A, Yamane H, Nishikawa R, Kimura Y, Yamaguchi N, Hikita K, Honda M, Takenaka A. Assessment of the accuracy of biparametric MRI/TRUS fusion-guided biopsy for index tumor evaluation using postoperative pathology specimens. BMC Urol 2024; 24:79. [PMID: 38575912 PMCID: PMC10996083 DOI: 10.1186/s12894-024-01473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Multiparametric MRI (mpMRI) is widely used for the diagnosis, surveillance, and staging of prostate cancer. However, it has several limitations, including higher costs, longer examination times, and the use of gadolinium-based contrast agents. This study aimed to investigate the accuracy of preoperatively assessed index tumors (ITs) using biparametric MRI (bpMRI)/transrectal ultrasound (TRUS) fusion biopsy compared with radical prostatectomy (RP) specimens. METHODS We included 113 patients diagnosed with prostate cancer through bpMRI/TRUS fusion-guided biopsies of lesions with a Prostate Imaging Reporting and Data System (PI-RADS) category ≥ 3. These patients underwent robot-assisted laparoscopic radical prostatectomy (RARP) at our institution between July 2017 and March 2023. We examined the localization of preoperative and postoperative ITs, the highest Gleason score (GS), and tumor diameter in these patients. RESULTS The preoperative cT stage matched the postoperative pT stage in 53 cases (47%), while 31 cases (27%) were upstaged, and 29 cases (26%) were downstaged (Weighted Kappa = 0.21). The preoperative and postoperative IT localizations were consistent in 97 cases (86%). The concordance rate between Gleason groups in targeted biopsies and RP specimens was 51%, with an upgrade in 25 cases (23%) and a downgrade in 27 cases (25%) (Weighted Kappa = 0.42). The maximum diameter of the IT and the maximum cancer core length on biopsy were correlated with the RP tumor's maximum diameter (p < 0.001 for both). CONCLUSION The diagnostic accuracy of bpMRI/TRUS fusion biopsy is comparable to mpMRI, suggesting that it can be a cost-effective and time-saving alternative.
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Affiliation(s)
- Ryutaro Shimizu
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan.
| | - Atsushi Yamamoto
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Hiroshi Yamane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Ryoma Nishikawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Yusuke Kimura
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Noriya Yamaguchi
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan
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Kwe J, Baunacke M, Boehm K, Platzek I, Thomas C, Borkowetz A. PI-RADS upgrading as the strongest predictor for the presence of clinically significant prostate cancer in patients with initial PI-RADS-3 lesions. World J Urol 2024; 42:84. [PMID: 38363332 PMCID: PMC10873230 DOI: 10.1007/s00345-024-04776-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Unclear lesions on multiparametric magnetic resonance tomography (mpMRI) are challenging for the indication of biopsy in patients with clinical suspicion of prostate cancer (PCa). The aim of this study is the validation of the detection rate of clinically significant PCa (csPCa) in patients with PI-RADS 3 findings and to determine the appropriate follow-up strategy. METHODS In this retrospective single-center study, patients with maximum PI-RADS 3 lesions underwent targeted MRI/ultrasound-fusion biopsy (tPbx) combined with systematic 12-core biopsy (sPbx) and follow-up mpMRI with further control biopsy. We assessed the evolution of MRI findings (PI-RADS, volume of the lesion), clinical parameters and histopathology in follow-up MRI and biopsies. The primary objective is the detection rate of csPCa, defined as ISUP ≥ 2 findings. RESULTS A total of 126 patients (median PSA 6.65 ng/ml; median PSA-density (PSAD) 0.13 ng/ml2) were included. The initial biopsy identified low-risk PCa in 24 cases (19%). During follow-up biopsy, 22.2% of patients showed PI-RADS upgrading (PI-RADS > 3), and 29 patients (23%) exhibited a tumor upgrading. Patients with PI-RADS upgrading had a higher risk of csPCa compared to those without PI-RADS upgrading (42.9% vs. 9.18%, p < 0.05). PI-RADS upgrading was identified as an independent predictor for csPCa in follow-up biopsy (OR 16.20; 95% CI 1.17-224.60; p = 0.038). CONCLUSION Patients with stable PI-RADS 3 findings may not require a follow-up biopsy. Instead, it is advisable to schedule an MRI, considering that PI-RADS upgrading serves as an independent predictor for csPCa.
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Affiliation(s)
- Jeremy Kwe
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Katharina Boehm
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Ivan Platzek
- Department of Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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Cai T, Tamanini I, Puglisi M, Bizzotto L, Rizzo M, Liguori G, Gallelli L, Palmieri A, Bjerklund Johansen TE. Phytotherapy Might Have a Role in Reducing Unnecessary Prostate Biopsies: Results from an Exploratory, Randomized Controlled Trial of Two Different Phytotherapeutic Agents. Clin Pract 2024; 14:188-197. [PMID: 38391402 PMCID: PMC10888467 DOI: 10.3390/clinpract14010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND We aimed to evaluate the impact of two different phytotherapeutic agents on decision making regarding prostate biopsy for patients with higher-than-normal prostate-specific antigen (PSA) levels. METHODS From June 2022 to May 2023, all patients attending two urological institutions due to higher-than-normal PSA levels were randomized to receive either oral capsules of Curcuma Longa, Boswellia, Pinus pinaster and Urtica dioica (Group A) or Serenoa Repens 320 mg (Group B) for 3 months. At the follow-up visit after 3 months, all patients underwent PSA tests and multiparametric magnetic resonance imaging (mpMRI). RESULTS In the per-protocol analysis, data from 66 patients in Group A and 76 in Group B were analyzed. Fifty patients in Group A (75.7%) showed a significant reduction in total PSA compared to forty-nine in Group B (64.4%) (p < 0.001). Twenty-eight patients had PI-RADS III or higher in mpMRI: twelve in Group A and fourteen in Group B. Twenty-three patients (34.8%) in Group A and fifty-nine (77.6%) in Group B (p < 0.001) underwent prostate biopsy based on the mpMRI findings and PSA values. Three patients in Group A showed a significant reduction in total PSA values while having positive mpMRI findings (6%) compared with nine in Group B (19.5%) (p < 0.001). On the contrary, 7 patients in Group A did not show significant reduction in total PSA values and had negative mpMRI findings (43%) compared to 22 in Group B (81.4%) (p < 0.001). CONCLUSIONS In conclusion, a three-month course of a combination of Curcuma Longa, Boswellia, Pinus pinaster and Urtica dioica seems to be an interesting tool to avoid unnecessary prostate biopsies among men with higher-than-normal PSA levels.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, 38122 Trento, Italy
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
| | - Irene Tamanini
- Department of Urology, Santa Chiara Regional Hospital, 38122 Trento, Italy
| | - Marco Puglisi
- Department of Urology, Santa Chiara Regional Hospital, 38122 Trento, Italy
| | | | - Michele Rizzo
- Department of Urology, University of Trieste, 34127 Trieste, Italy
| | - Giovanni Liguori
- Department of Urology, University of Trieste, 34127 Trieste, Italy
| | - Luca Gallelli
- Department of Health Science, School of Medicine, University of Catanzaro, 88100 Catanzaro, Italy
| | - Alessandro Palmieri
- Department of Urology, University of Naples Federico II, 80138 Naples, Italy
| | - Truls E Bjerklund Johansen
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
- Department of Urology, Oslo University Hospital, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Aarhus, 8000 Aarhus, Denmark
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Reesink DJ, Arteaga de Castro CS, Van der Velden T, Van Vooren J, Oost P, Jonges TGN, Lam MGEH, de Keizer B, Willemse PPM, Meijer RP, Klomp DWJ. Feasibility of clinical studies of chemical exchange saturation transfer magnetic resonance imaging of prostate cancer at 7 T. NMR IN BIOMEDICINE 2023; 36:e4958. [PMID: 37094995 DOI: 10.1002/nbm.4958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
Chemical exchange saturation transfer (CEST) has been explored for differentiation between tumour and benign tissue in prostate cancer (PCa) patients. With ultrahigh field strengths such as 7-T, the increase of spectral resolution and sensitivity could allow for selective detection of amide proton transfer (APT) at 3.5 ppm and a group of compounds that resonate at 2 ppm (i.e., [poly]amines and/or creatine). The potential of 7-T multipool CEST analysis of the prostate and the detection of PCa was studied in patients with proven localised PCa who were scheduled to undergo robot-assisted radical prostatectomy (RARP). Twelve patients were prospectively included (mean age 68.0 years, mean serum prostate-specific antigen 7.8ng/mL). A total of 24 lesions larger than 2 mm were analysed. Used were 7-T T2-weighted (T2W) imaging and 48 spectral CEST points. Patients received 1.5-T/3-T prostate magnetic resonance imaging and galium-68-prostate-specific membrane antigen-positron emission tomography/computerised tomography to determine the location of the single-slice CEST. Based on the histopathological results after RARP, three regions of interest were drawn on the T2W images from a known malignant zone and benign zone in the central and peripheral zones. These areas were transposed to the CEST data, from which the APT and 2-ppm CEST were calculated. The statistical significance of the CEST between the central zone, the peripheral zone, and tumour was calculated using a Kruskal-Wallis test. The z-spectra showed that APT and even a distinct pool that resonated at 2 ppm were detectable. This study showed a difference trend in the APT levels, but no difference in the 2-ppm levels when tested between the central zone, the peripheral zone, and tumour (H(2) = 4.8, p = 0.093 and H(2) = 0.86, p = 0.651, respectively). Thus, to conclude, we could most likely detect APT and amines and/or creatine levels noninvasively in prostate using the CEST effect. At group level, CEST showed a higher level of APT in the peripheral versus the central zone; however, no differences of APT and 2-ppm levels were observed in tumours.
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Affiliation(s)
- Daan J Reesink
- Department of Oncological Urology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catalina S Arteaga de Castro
- Department of Precision Imaging, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tijl Van der Velden
- Department of Precision Imaging, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanette Van Vooren
- Department of Radiology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petri Oost
- Department of Urology, Tergooi Hospital Hilversum, Hilversum, The Netherlands
| | - Trudy G N Jonges
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter-Paul M Willemse
- Department of Oncological Urology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis W J Klomp
- Department of Precision Imaging, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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Zhou C, Zhang YF, Guo S, Wang D, Lv HX, Qiao XN, Wang R, Chang DH, Zhao LM, Zhou FH. Multiparametric MRI radiomics in prostate cancer for predicting Ki-67 expression and Gleason score: a multicenter retrospective study. Discov Oncol 2023; 14:133. [PMID: 37470865 PMCID: PMC10361451 DOI: 10.1007/s12672-023-00752-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE Prostate cancer (PCa) with high Ki-67 expression and high Gleason Scores (GS) tends to have aggressive clinicopathological characteristics and a dismal prognosis. In order to predict the Ki-67 expression status and the GS in PCa, we sought to construct and verify MRI-based radiomics signatures. METHODS AND MATERIALS We collected T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) images from 170 PCa patients at three institutions and extracted 321 original radiomic features from each image modality. We used support vector machine (SVM) and least absolute shrinkage and selection operator (LASSO) logistic regression to select the most informative radiomic features and built predictive models using up sampling and feature selection techniques. Using receiver operating characteristic (ROC) analysis, the discriminating power of this feature was determined. Subsequent decision curve analysis (DCA) assessed the clinical utility of the radiomic features. The Kaplan-Meier (KM) test revealed that the radiomics-predicted Ki-67 expression status and GS were prognostic factors for PCa survival. RESULT The hypothesized radiomics signature, which included 15 and 9 selected radiomics features, respectively, was significantly correlated with pathological Ki-67 and GS outcomes in both the training and validation datasets. Areas under the curve (AUC) for the developed model were 0.813 (95% CI 0.681,0.930) and 0.793 (95% CI 0.621, 0.929) for the training and validation datasets, respectively, demonstrating discrimination and calibration performance. The model's clinical usefulness was verified using DCA. In both the training and validation sets, high Ki-67 expression and high GS predicted by radiomics using SVM models were substantially linked with poor overall survival (OS). CONCLUSIONS Both Ki-67 expression status and high GS correlate with PCa patient survival outcomes; therefore, the ability of the SVM classifier-based model to estimate Ki-67 expression status and the Lasso classifier-based model to assess high GS may enhance clinical decision-making.
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Affiliation(s)
- Chuan Zhou
- The First Clinical Medical College of Lanzhou University, Lanzhou, 73000, China
| | - Yun-Feng Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Sheng Guo
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Dong Wang
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Hao-Xuan Lv
- The First Clinical Medical College of Lanzhou University, Lanzhou, 73000, China
| | - Xiao-Ni Qiao
- Department of Information Management, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Rong Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 73000, China
- Department of Nuclear Medicine, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - De-Hui Chang
- Department of Urology, The 940 Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, 730000, China
| | - Li-Ming Zhao
- Department of Urology, Second People's Hospital of Gansu Province, Lanzhou, 730000, China
| | - Feng-Hai Zhou
- The First Clinical Medical College of Lanzhou University, Lanzhou, 73000, China.
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, China.
- Department of Urology, Gansu Provincial Hospital, Lanzhou, 730000, China.
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D W, L G, T Z, W X, L Y, Z X, Z W, L G, H Y. Study of iron metabolism based on T2* mapping sequences in PI-RADS 3 prostate lesions. Front Oncol 2023; 13:1185057. [PMID: 37274247 PMCID: PMC10232975 DOI: 10.3389/fonc.2023.1185057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Prostate cancer is one of the most common malignant tumors in Chinese men, which is rich in iron metabolic activity and is closely related to all stages of prostate cancer progression. Since the current diagnostic methods are insufficient, we aimed to evaluate the value of quantitative T2 star values from the T2* mapping sequences in multiparametric magnetic resonance imaging (mpMRI) in the diagnosis and grading of PI-RADS 3 prostate cancer (PCa). Methods We prospectively enrolled patients with PCa or benign prostatic hyperplasia (BPH) admitted to our hospital from January 2021 to November 2022. Imaging indicators, including the T2* value and apparent diffusion coefficient (ADC) value, were collected, and enzyme-linked immunosorbent assays (ELISAs) were used to measure the levels of proteins involved in iron metabolism in the patients. ROC curves were drawn to explore whether the T2* value could be used for the diagnosis and grading of PCa. Results We found that three iron metabolism indexes, ferritin, hepcidin, and the ferric ion (Fe), and the T2* value were significantly different between the PCa group and BPH group and between the low International Society of Urology Pathology (ISUP) group (ISUP ≤ 2) and the high ISUP group (ISUP>2). Additionally, there was a significant correlation between the levels of these three indicators and the T2* value. Further ROC analysis showed that the levels of iron metabolism-related indexes and T2* values performed well in diagnosing and grading PCa. Discussion The T2* value has good value in detecting and predicting the grade of prostate cancer and can reflect the iron metabolism of the tumor, which could provide a foundation for the diagnosis and grading of PCa in the future.
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Affiliation(s)
- Wenhao D
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guangzheng L
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhen T
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuedong W
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yonggang L
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuefeng Z
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weijie Z
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gang L
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhua H
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Orlando N, Edirisinghe C, Gyacskov I, Vickress J, Sachdeva R, Gomez JA, D'Souza D, Velker V, Mendez LC, Bauman G, Fenster A, Hoover DA. Validation of a surface-based deformable MRI-3D ultrasound image registration algorithm toward clinical implementation for interstitial prostate brachytherapy. Brachytherapy 2023; 22:199-209. [PMID: 36641305 DOI: 10.1016/j.brachy.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to evaluate and clinically implement a deformable surface-based magnetic resonance imaging (MRI) to three-dimensional ultrasound (US) image registration algorithm for prostate brachytherapy (BT) with the aim to reduce operator dependence and facilitate dose escalation to an MRI-defined target. METHODS AND MATERIALS Our surface-based deformable image registration (DIR) algorithm first translates and scales to align the US- and MR-defined prostate surfaces, followed by deformation of the MR-defined prostate surface to match the US-defined prostate surface. The algorithm performance was assessed in a phantom using three deformation levels, followed by validation in three retrospective high-dose-rate BT clinical cases. For comparison, manual rigid registration and cognitive fusion by physician were also employed. Registration accuracy was assessed using the Dice similarity coefficient (DSC) and target registration error (TRE) for embedded spherical landmarks. The algorithm was then implemented intraoperatively in a prospective clinical case. RESULTS In the phantom, our DIR algorithm demonstrated a mean DSC and TRE of 0.74 ± 0.08 and 0.94 ± 0.49 mm, respectively, significantly improving the performance compared to manual rigid registration with 0.64 ± 0.16 and 1.88 ± 1.24 mm, respectively. Clinical results demonstrated reduced variability compared to the current standard of cognitive fusion by physicians. CONCLUSIONS We successfully validated a DIR algorithm allowing for translation of MR-defined target and organ-at-risk contours into the intraoperative environment. Prospective clinical implementation demonstrated the intraoperative feasibility of our algorithm, facilitating targeted biopsies and dose escalation to the MR-defined lesion. This method provides the potential to standardize the registration procedure between physicians, reducing operator dependence.
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Affiliation(s)
- Nathan Orlando
- Department of Medical Biophysics, Western University, London, Ontario, Canada; Robarts Research Institute, Western University, London, Ontario, Canada.
| | | | - Igor Gyacskov
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Jason Vickress
- Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Robin Sachdeva
- Lawson Health Research Institute, London, Ontario, Canada
| | - Jose A Gomez
- London Health Sciences Centre, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - David D'Souza
- Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Vikram Velker
- Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Lucas C Mendez
- Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Glenn Bauman
- Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, Western University, London, Ontario, Canada; Robarts Research Institute, Western University, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada
| | - Douglas A Hoover
- Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
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Payrard-Starck C, Fourcade A, An Nguyen T, Tissot V, Doucet L, Marolleau J, Lucas C, Fournier G, Valeri A. Direct comparison between Grade Group assessed on systematic and MRI/ultrasound fusion targeted biopsies correlated to the radical prostatectomy specimens in patients with prostate cancer. Prog Urol 2023; 33:265-271. [PMID: 36740508 DOI: 10.1016/j.purol.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/02/2022] [Accepted: 01/16/2023] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To compare the correlation of Gleason score (GS) and ISUP grade determined by prostate biopsies (PBx) and radical prostatectomy (RP) specimens according to the biopsy technique: ultrasound randomised (RBx) vs. MRI/ultrasound fusion targeted (TBx). MATERIALS AND METHODS Between March 2013 and June 2018, we retrospectively included patients who underwent RP for prostate cancer (PCa) histopathologically proven by RBx and/or TBx. All patients had a prebiopsy MRI by a single radiologist (using PI-RADS score), then transrectal RBx (12cores, blinded to MRI lesions) and TBx (2-4 cores/target) with elastic MRI/ultrasound fusion (UroStation™, Koelis, Grenoble, France). Histological findings were compared: PBx vs. RP. RESULTS One hundred and four patients underwent RP after RBx and/or TBx. ISUP concordance rate was better with the association RBx+TBx 49% (51/104) vs. 43.3% with TBx (P=0.07) and 43.3% with RBx (P=0.13). With RBx, 50% of the patients were downgraded (52/104) against 42.3% (44/104) with TBx (P=0.088). The association RBx+TBx significantly decreased the rate of downgrading of the ISUP score compared to the ISUP score of RP 35.6% (37/104) vs. RBx (50%, P=0.0001) and vs. TBx (42.3%, P=0.016). CONCLUSION In half of cases, the ISUP score was underestimated in RBx compared to RP specimens. Adding TBx to RBx significantly reduced downgrading. The combination of both biopsy techniques appeared to be the best protocol to get closer to ISUP score and GS of the RP specimens. LEVEL OF EVIDENCE C.
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Affiliation(s)
- C Payrard-Starck
- Urology Department, CHU Brest, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France.
| | - A Fourcade
- Urology Department, CHU Brest, Brest, France
| | - T An Nguyen
- Urology Department, CHU Brest, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France; LaTIM, Inserm, UMR 1101, CHU Brest, Brest, France
| | - V Tissot
- Radiology Department, CHU Brest, Brest, France
| | - L Doucet
- Pathology Department, CHU Brest, Brest, France
| | - J Marolleau
- Urology Department, CHU Brest, Brest, France
| | - C Lucas
- Urology Department, CHU Brest, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France
| | - G Fournier
- Urology Department, CHU Brest, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France; LaTIM, Inserm, UMR 1101, CHU Brest, Brest, France
| | - A Valeri
- Urology Department, CHU Brest, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France; LaTIM, Inserm, UMR 1101, CHU Brest, Brest, France
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Ng J, Gregucci F, Pennell RT, Nagar H, Golden EB, Knisely JPS, Sanfilippo NJ, Formenti SC. MRI-LINAC: A transformative technology in radiation oncology. Front Oncol 2023; 13:1117874. [PMID: 36776309 PMCID: PMC9911688 DOI: 10.3389/fonc.2023.1117874] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
Advances in radiotherapy technologies have enabled more precise target guidance, improved treatment verification, and greater control and versatility in radiation delivery. Amongst the recent novel technologies, Magnetic Resonance Imaging (MRI) guided radiotherapy (MRgRT) may hold the greatest potential to improve the therapeutic gains of image-guided delivery of radiation dose. The ability of the MRI linear accelerator (LINAC) to image tumors and organs with on-table MRI, to manage organ motion and dose delivery in real-time, and to adapt the radiotherapy plan on the day of treatment while the patient is on the table are major advances relative to current conventional radiation treatments. These advanced techniques demand efficient coordination and communication between members of the treatment team. MRgRT could fundamentally transform the radiotherapy delivery process within radiation oncology centers through the reorganization of the patient and treatment team workflow process. However, the MRgRT technology currently is limited by accessibility due to the cost of capital investment and the time and personnel allocation needed for each fractional treatment and the unclear clinical benefit compared to conventional radiotherapy platforms. As the technology evolves and becomes more widely available, we present the case that MRgRT has the potential to become a widely utilized treatment platform and transform the radiation oncology treatment process just as earlier disruptive radiation therapy technologies have done.
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Affiliation(s)
- John Ng
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States,*Correspondence: John Ng,
| | - Fabiana Gregucci
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States,Department of Radiation Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Ryan T. Pennell
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Encouse B. Golden
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | | | | | - Silvia C. Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
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10
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Suguino RK, Mussi TC, Coelho FMA, Baroni RH. Prostate imaging features on magnetic resonance imaging of young patients. EINSTEIN-SAO PAULO 2022; 20:eAO0024. [PMID: 36477522 DOI: 10.31744/einstein_journal/2022ao0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To identify magnetic resonance imaging findings of the prostate in young adults, including symptomatic and asymptomatic patients. The aim of this study is to evaluate the main aspects of prostate imaging in young patients. METHODS A total of 102 patients under 40 years of age, who underwent prostate magnetic resonance imaging between January 2016 and January 2019, were included in this study. The patients were divided into two groups: symptomatic for prostatitis (Group 1) and asymptomatic (Group 2). Magnetic resonance imaging scans were anonymized and interpreted by a radiologist blinded for clinical information. The study evaluated peripheral zone signal in T2-weighted sequences, diffusion and apparent diffusion coefficient map; peripheral zone enhancement pattern; seminal vesicles and periprostatic fat. RESULTS All evaluated criteria did not present statistically significant differences between the two groups. The most common pattern was heterogeneous hyposignal on T2 (57.9% in Group 1 and 57.8% in Group 2; p=0.506), mild diffuse / wedge-shaped areas of hypointensity on apparent diffusion coefficient map (61.4% in Group 1 and 64.4% in Group 2; p=0.931) and early post-contrast enhancement (73.7% in Group 1 and 68.9% in Group 2, p=0719). CONCLUSION The magnetic resonance imaging aspect of young patients showed no differences between symptomatic and asymptomatic patients.
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11
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The Added Value of [18F]Choline PET/CT in Low-Risk Prostate Cancer Staging: A Case Report. Life (Basel) 2022; 12:life12111728. [DOI: 10.3390/life12111728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
In the management of prostate cancer (PCa), correct staging is crucial in order to assess the right therapeutic approach. [18F]Choline PET/CT has been shown to provide more accurate staging information than conventional imaging approaches. The aim of this paper is to provide a real practice demonstration of the impact of [18F]Choline PET/CT on low-risk prostate cancer staging and clinical management. We report a 64-year-old man with biochemical PCa recurrence diagnosis after transurethral resection of the prostate. The patient, after the detection of an increased level of PSA, underwent multi-parametric prostate magnetic resonance imaging (mpMRI) that did not show evidence of disease. The patient was admitted to perform [18F]Choline PET/CT that showed a macroscopic prostate recurrence. Patient underwent photon external beam radiation therapy (EBRT) treatment, and [18F]Choline PET/CT was also used to define treatment volumes. At 3- and 6-month clinical follow-up evaluations, no late toxicity was detected and a significant reduction in PSA value was shown. Therefore, our case highlights the potential usefulness of [18F]Choline PET/CT for the staging of low-risk prostate cancer and its impact on the management and quality of life of such patients. The presented case should urge the scientific community to enhance larger and multicentric studies, assessing more extensively the potential impact of [18F]Choline PET/CT in this clinical scenario.
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12
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Zhu Z, Zhu Y, Xiao Y, Hu S. Indications for nerve-sparing surgery for radical prostatectomy: Results from a single-center study. Front Oncol 2022; 12:896033. [PMID: 35965515 PMCID: PMC9372405 DOI: 10.3389/fonc.2022.896033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To explore the clinical indications of using the nerve-sparing technique in radical prostatectomy. Patients and methods We retrospectively analyzed the clinical and pathological data of 101 patients who underwent radical prostatectomy (RP) at our institution. Twenty-five patients underwent open surgery, and 76 patients underwent laparoscopic surgery. The biochemical recurrence (BCR) rate was analyzed by the method of Kaplan–Meier. The distance between the ipsilateral neurovascular bundles (NVBs) and foci of prostate tumor (N-T distance) was measured in postoperative specimens. We defined the N-T distance >2 mm as the threshold to perform nerve-sparing (NS) in RP. Through logistic regression analysis, we determined the preoperative clinical indications for the nerve-sparing technique in RP. Results The average BCR-free survival time was 53.2 months in these 101 patients with RP, with the 3- and 5-year BCR-free rates being 87.9% and 85.8%, respectively. The N-T distance was measured in 184 prostate sides from postoperative specimens of 101 patients. Univariate analysis showed that the percent of side-specific biopsy cores with cancer (≥1/3), maximum tumor length in biopsy core (≥5 mm), average percent involvement of each positive core (≥50%), PI-RADS score, and prostate MP-MRI imaging (extra-capsular extension) were associated with the N-T distance (p < 0.003). Furthermore, the percent of side-specific biopsy cores with cancer (≥1/3) (OR = 4.11, p = 0.0047) and prostate MP-MRI imaging (extra-capsular extension) (OR = 3.92, p = 0.0061) were found to be statistically significant independent predictors of the N-T distance in multivariate analysis. Conclusions The clinical indications of nerve-sparing RP were <1/3 side-specific biopsy cores with cancer and no extra-capsular extension by prostate MP-MRI examination.
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Affiliation(s)
- Zaisheng Zhu
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
- *Correspondence: Zaisheng Zhu,
| | - Yiyi Zhu
- National Health Commission (NHC) Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yunyuan Xiao
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
| | - Shengye Hu
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
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13
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Wei G, Reeves F, Perera M, Kelly BD, Esler S, Bolton D, Jack G. The impact of health-policy-driven subsidisation of prostate magnetic resonance imaging on transperineal prostate biopsy practice and outcomes. BJUI COMPASS 2022; 3:304-309. [PMID: 35783586 PMCID: PMC9231672 DOI: 10.1002/bco2.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/13/2021] [Accepted: 01/13/2022] [Indexed: 12/24/2022] Open
Abstract
Background From 1 July 2018, the Australian Medicare Benefits Schedule (MBS) introduced rebates for multi-parametric magnetic resonance imaging (mpMRI) for the workup for prostate cancer (PCa). We aimed to determine if subsidisation of mpMRI prior to transperineal biopsy altered our institution's prostate biopsy practice patterns and outcomes. Methods All patients who underwent transperineal prostate biopsy at an Australian tertiary institution from 1 January 2017 to 1 January 2020 were identified. Patients with known PCa were excluded. Patients were stratified into two groups: a pre-subsidisation cohort comprising patients biopsied prior to the introduction of mpMRI subsidisation on 1 July 2018 and a post-subsidisation cohort comprising patients biopsied after 1 July 2018. Histopathological results were compared with further stratification based on mpMRI results. Clinically significant cancer was defined as ISUP Grade Group ≥ 2. Results Six hundred and fifty men fulfilled the inclusion criteria. Three hundred and sixty-one patients were in the pre-subsidisation cohort and 289 in the post-subsidisation cohort. Of the patients in the pre-subsidisation group, 36.3% underwent a pre-biopsy mpMRI compared with 77.5% in the post-subsidisation group. Of the patients in the pre-subsidisation group, 59.6% had positive biopsies (p = 0.024) compared with 68.2% in the post-subsidisation group. The rate of clinically significant PCa was lower in the pre-subsidisation group (39.1%) compared with the post-subsidisation (49.5%, p = 0.008). The negative predictive value of mpMRI for clinically significant PCa was 86.5%. Conclusion Our institution experienced a reduction of negative prostate biopsies and an increase in clinically significant PCa within transperineal biopsy specimens after the Australian healthcare system introduced financial subsidisation of mpMRI.
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Affiliation(s)
- Gavin Wei
- Department of SurgeryAustin Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Fairleigh Reeves
- Department of SurgeryAustin Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Marlon Perera
- Department of SurgeryAustin Health, The University of MelbourneMelbourneVictoriaAustralia
- Olivia Newton‐John Cancer and Wellness CentreAustin HealthHeidelbergVictoriaAustralia
- Department of UrologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Brian D. Kelly
- Department of SurgeryAustin Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Stephen Esler
- Department of RadiologyAustin Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Damien Bolton
- Department of SurgeryAustin Health, The University of MelbourneMelbourneVictoriaAustralia
- Olivia Newton‐John Cancer and Wellness CentreAustin HealthHeidelbergVictoriaAustralia
| | - Greg Jack
- Department of SurgeryAustin Health, The University of MelbourneMelbourneVictoriaAustralia
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14
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Fan Y, Mulati Y, Zhai L, Chen Y, Wang Y, Feng J, Yu W, Zhang Q. Diagnostic Accuracy of Contemporary Selection Criteria in Prostate Cancer Patients Eligible for Active Surveillance: A Bayesian Network Meta-Analysis. Front Oncol 2022; 11:810736. [PMID: 35083157 PMCID: PMC8785217 DOI: 10.3389/fonc.2021.810736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
Background Several active surveillance (AS) criteria have been established to screen insignificant prostate cancer (insigPCa, defined as organ confined, low grade and small volume tumors confirmed by postoperative pathology). However, their comparative diagnostic performance varies. The aim of this study was to compare the diagnostic accuracy of contemporary AS criteria and validate the absolute diagnostic odds ratio (DOR) of optimal AS criteria. Methods First, we searched Pubmed and performed a Bayesian network meta-analysis (NMA) to compare the diagnostic accuracy of contemporary AS criteria and obtained a relative ranking. Then, we searched Pubmed again to perform another meta-analysis to validate the absolute DOR of the top-ranked AS criteria derived from the NMA with two endpoints: insigPCa and favorable disease (defined as organ confined, low grade tumors). Subgroup and meta-regression analyses were conducted to identify any potential heterogeneity in the results. Publication bias was evaluated. Results Seven eligible retrospective studies with 3,336 participants were identified for the NMA. The diagnostic accuracy of AS criteria ranked from best to worst, was as follows: Epstein Criteria (EC), Yonsei criteria, Prostate Cancer Research International: Active Surveillance (PRIAS), University of Miami (UM), University of California-San Francisco (UCSF), Memorial Sloan-Kettering Cancer Center (MSKCC), and University of Toronto (UT). I2 = 50.5%, and sensitivity analysis with different insigPCa definitions supported the robustness of the results. In the subsequent meta-analysis of DOR of EC, insigPCa and favorable disease were identified as endpoints in ten and twenty-two studies, respectively. The pooled DOR for insigPCa and favorable disease were 0.44 (95%CI, 0.31–0.58) and 0.66 (95%CI, 0.61–0.71), respectively. According to a subgroup analysis, the DOR for favorable disease was significantly higher in US institutions than that in other regions. No significant heterogeneity or evidence of publication bias was identified. Conclusions Among the seven AS criteria evaluated in this study, EC was optimal for positively identifying insigPCa patients. The pooled diagnostic accuracy of EC was 0.44 for insigPCa and 0.66 when a more liberal endpoint, favorable disease, was used. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/], PROSPERO [CRD42020157048].
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Affiliation(s)
- Yu Fan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China.,Department of Urology, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Yelin Mulati
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Lingyun Zhai
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuke Chen
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Yu Wang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Juefei Feng
- Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Qian Zhang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China.,Peking University Binhai Hospital, Tianjin, China
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15
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Hall WA, Paulson E, Li XA, Erickson B, Schultz C, Tree A, Awan M, Low DA, McDonald BA, Salzillo T, Glide-Hurst CK, Kishan AU, Fuller CD. Magnetic resonance linear accelerator technology and adaptive radiation therapy: An overview for clinicians. CA Cancer J Clin 2022; 72:34-56. [PMID: 34792808 PMCID: PMC8985054 DOI: 10.3322/caac.21707] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/01/2021] [Accepted: 09/22/2021] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy (RT) continues to play an important role in the treatment of cancer. Adaptive RT (ART) is a novel method through which RT treatments are evolving. With the ART approach, computed tomography or magnetic resonance (MR) images are obtained as part of the treatment delivery process. This enables the adaptation of the irradiated volume to account for changes in organ and/or tumor position, movement, size, or shape that may occur over the course of treatment. The advantages and challenges of ART maybe somewhat abstract to oncologists and clinicians outside of the specialty of radiation oncology. ART is positioned to affect many different types of cancer. There is a wide spectrum of hypothesized benefits, from small toxicity improvements to meaningful gains in overall survival. The use and application of this novel technology should be understood by the oncologic community at large, such that it can be appropriately contextualized within the landscape of cancer therapies. Likewise, the need to test these advances is pressing. MR-guided ART (MRgART) is an emerging, extended modality of ART that expands upon and further advances the capabilities of ART. MRgART presents unique opportunities to iteratively improve adaptive image guidance. However, although the MRgART adaptive process advances ART to previously unattained levels, it can be more expensive, time-consuming, and complex. In this review, the authors present an overview for clinicians describing the process of ART and specifically MRgART.
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MESH Headings
- History, 20th Century
- History, 21st Century
- Humans
- Magnetic Resonance Imaging, Interventional/history
- Magnetic Resonance Imaging, Interventional/instrumentation
- Magnetic Resonance Imaging, Interventional/methods
- Magnetic Resonance Imaging, Interventional/trends
- Neoplasms/diagnostic imaging
- Neoplasms/radiotherapy
- Particle Accelerators
- Radiation Oncology/history
- Radiation Oncology/instrumentation
- Radiation Oncology/methods
- Radiation Oncology/trends
- Radiotherapy Planning, Computer-Assisted/history
- Radiotherapy Planning, Computer-Assisted/instrumentation
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy Planning, Computer-Assisted/trends
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Affiliation(s)
- William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - X. Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher Schultz
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alison Tree
- The Royal Marsden National Health Service Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Musaddiq Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel A. Low
- Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, California
| | - Brigid A. McDonald
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Travis Salzillo
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Carri K. Glide-Hurst
- Department of Radiation Oncology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Amar U. Kishan
- Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, California
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
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16
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Gaudiano C, Bianchi L, Corcioni B, Giunchi F, Schiavina R, Ciccarese F, Braccischi L, Rustici A, Fiorentino M, Brunocilla E, Golfieri R. Evaluating the performance of clinical and radiological data in predicting prostate cancer in prostate imaging reporting and data system version 2.1 category 3 lesions of the peripheral and the transition zones. Int Urol Nephrol 2021; 54:263-271. [PMID: 34822065 DOI: 10.1007/s11255-021-03071-7] [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] [Received: 08/19/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To define the value of clinical and radiological data, using multiparametric magnetic resonance imaging (mpMRI), to predict prostate cancer (PCa) in prostate imaging reporting and data system version 2.1 (PIRADSv2.1) 3 lesions of the peripheral and the transition zones (PZ and TZ). METHODS The mpMRI of patients with PIRADSv2.1 3 lesions who had undergone fusion targeted biopsy was reviewed. Morphological pattern, diffusion parameters and vascularisation were evaluated. The radiological/histopathological data of benign and malignant lesions, between the PZ and TZ were compared. Univariate and multivariate analyses were carried out to identify the clinical and radiological data capable of predicting PCa. RESULTS One hundred and twenty-three lesions were assessed, 93 (76%) in the PZ and 30 (24%) in the TZ. Of these, 56 (46%) were PCa and 67 (54%) were benign. The majority of the PCas were Grade Group System (GGS) 1 (38%) and GGS 2 (39%); tumours having a GGS ≥ 3 were more frequently in the TZ (p = 0.02). Univariate analysis showed a significant correlation between PCa and prostate volume, prostate-specific antigen (PSA) density, lesion zone and the apparent diffusion coefficient. At multivariate logistic regression PSA density > 0.15 ng/ml/ml {Odds ratio [OR] 2.38; p = 0.001} and lesion zone (i.e. TZ OR 7.55) were independent predictors of PCa (all p ≤ 0.04). CONCLUSION In solitary PIRADSv2.1 3 lesions, the most important predictive factor was the location zone, with a much greater risk for TZ lesions.
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Affiliation(s)
- Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
| | - Lorenzo Bianchi
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Beniamino Corcioni
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Francesca Giunchi
- Department of Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Federica Ciccarese
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Lorenzo Braccischi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Arianna Rustici
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Michelangelo Fiorentino
- Department of Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.,Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Via Massarenti 9, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
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17
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Samtani S, Burotto M, Roman JC, Cortes-Herrera D, Walton-Diaz A. MRI and Targeted Biopsy Essential Tools for an Accurate Diagnosis and Treatment Decision Making in Prostate Cancer. Diagnostics (Basel) 2021; 11:diagnostics11091551. [PMID: 34573893 PMCID: PMC8466276 DOI: 10.3390/diagnostics11091551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) is one of the most frequent causes of cancer death worldwide. Historically, diagnosis was based on physical examination, transrectal (TRUS) images, and TRUS biopsy resulting in overdiagnosis and overtreatment. Recently magnetic resonance imaging (MRI) has been identified as an evolving tool in terms of diagnosis, staging, treatment decision, and follow-up. In this review we provide the key studies and concepts of MRI as a promising tool in the diagnosis and management of prostate cancer in the general population and in challenging scenarios, such as anteriorly located lesions, enlarged prostates determining extracapsular extension and seminal vesicle invasion, and prior negative biopsy and the future role of MRI in association with artificial intelligence (AI).
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Affiliation(s)
- Suraj Samtani
- Clinical Research Center, Bradford Hill, Santiago 8420383, Chile; (S.S.); (M.B.)
- Fundacion Chilena de Inmuno Oncologia, Santiago 8420383, Chile
| | - Mauricio Burotto
- Clinical Research Center, Bradford Hill, Santiago 8420383, Chile; (S.S.); (M.B.)
- Oncología Médica, Clinica Universidad de los Andes, Santiago 7620157, Chile
| | - Juan Carlos Roman
- Urofusion Chile, Santiago 7500010, Chile; (J.C.R.); (D.C.-H.)
- Servicio de Urologia, Instituto Nacional del Cancer, Santiago 8380455, Chile
| | | | - Annerleim Walton-Diaz
- Urofusion Chile, Santiago 7500010, Chile; (J.C.R.); (D.C.-H.)
- Servicio de Urologia, Instituto Nacional del Cancer, Santiago 8380455, Chile
- Departamento de Oncologia Básico-Clinico Universidad de Chile, Santiago 8380455, Chile
- Correspondence:
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18
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Uno H, Taniguchi T, Seike K, Kato D, Takai M, Iinuma K, Horie K, Nakane K, Koie T. The accuracy of prostate cancer diagnosis in biopsy-naive patients using combined magnetic resonance imaging and transrectal ultrasound fusion-targeted prostate biopsy. Transl Androl Urol 2021; 10:2982-2989. [PMID: 34430401 PMCID: PMC8350232 DOI: 10.21037/tau-21-250] [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: 03/22/2021] [Accepted: 06/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to estimate whether multiparametric magnetic resonance imaging (mpMRI)-transrectal ultrasound (TRUS) fusion biopsy (FUS-TB) increases the detection rates of clinically significant prostate cancer (csPCa) compared with TRUS-guided systematic biopsy (TRUS-GB). Methods This retrospective study focused on patients who underwent mpMRI before prostate biopsy (PB) with Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) scores ≥3 and prostate-specific antigen (PSA) level between 2.5 and 20 ng/mL. Before FUS-TB, the biopsy needle position was checked virtually using three-dimensional mapping. After confirming the position of the target within the prostate, biopsy needle was inserted and PB was performed. Suspicious lesions were generally targeted with 2 to 4 cores. Subsequently, 10–12 cores were biopsied for TRUS-GB. The primary endpoint was the PCa detection rate (PCDR) for patients with PCa who underwent combined FUS-TB and TRUS-GB. Results According to PI-RADS v2, 76.7% of the patients with PI-RADS v2 score ≥3 were diagnosed with PCa. The PCDRs in patients with PI-RADS v2 score of 4 or 5 were significantly higher than those in patients with PI-RADS v2 score of 3 (3 vs. 4, P<0.001; 3 vs. 5, P<0.001; 4 vs. 5, P=0.073). According to PCDR, the detection rates of PCa and csPCa in the FUS-TB were significantly higher than that in the TRUS-GB. Conclusions Following detection of suspicious tumor lesions on mpMRI, FUS-TB use detects a higher number of PCa cases compared with TRUS-GB.
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Affiliation(s)
- Hiromi Uno
- Department of Urology, Chuno Kosei Hospital, Seki, Japan
| | | | - Kensaku Seike
- Department of Urology, Chuno Kosei Hospital, Seki, Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kengo Horie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
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19
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Deal M, Bardet F, Walker PM, de la Vega MF, Cochet A, Cormier L, Bentellis I, Loffroy R. Three-dimensional nuclear magnetic resonance spectroscopy: a complementary tool to multiparametric magnetic resonance imaging in the identification of aggressive prostate cancer at 3.0T. Quant Imaging Med Surg 2021; 11:3749-3766. [PMID: 34341747 DOI: 10.21037/qims-21-331] [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] [Received: 03/25/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022]
Abstract
Background The limitations of the assessment of tumor aggressiveness by Prostate Imaging Reporting and Data System (PI-RADS) and biopsies suggest that the diagnostic algorithm could be improved by quantitative measurements in some chosen indications. We assessed the tumor high-risk predictive performance of 3.0 Tesla (3.0T) multiparametric magnetic resonance imaging (mp-MRI) combined with nuclear magnetic resonance spectroscopic sequences (NMR-S) in order to show that the metabolic analysis could bring out an evocative result for the aggressive form of prostate cancer. Methods We conducted a retrospective study of 26 patients (mean age, 62.4 years) who had surgery for prostate cancer between 2009 and 2016 after pre-therapeutic assessment with 3.0T mp-MRI and NMR-S. Groups within the intermediate range of the D'Amico risk classification were divided into two categories, low risk (n=20) and high risk (n=6), according to the International Society of Urological Pathology (ISUP) 2-3 limit. Histoprognostic discordances within various risk groups were compared with the corresponding predictive MRI values. The performance of predictive models was assessed based on sensitivity, specificity, and the area under the curve (AUC) of receiver operating characteristic (ROC) curves. Results After prostatectomy, histological analysis reclassified 18 patients as high-risk, including 16 who were T3 MRI grade, of whom 13 (81.3%) were found to be pT3. Among the patients who had cT1 or cT2 digital rectal examinations, the T3 MRI factor multiplied by 8.7 [odds ratio (OR), 8.7; 95% confidence interval (CI), 1.3-56.2; P=0.024] the relative risk of being pT3 and by 5.8 (OR, 5.8; 95% CI, 0.95-35.7; P=0.05) the relative risk of being pGleason (pGS) > GS-prostate biopsy. Spectroscopic data showed that the choline concentration was significantly higher (P=0.001) in aggressive disease. Conclusions The predictive model of tumor aggressiveness combining mp-MRI plus NMR-S was better than the mp-MRI model alone (AUC, 0.95 vs. 0.86). Information obtained by mp-MRI coupled with spectroscopy may improve the detection of occult aggressive disease, helping in the discrimination of intermediate risks.
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Affiliation(s)
- Michael Deal
- Department of Urology and Andrology, Arnault Tzanck Private Institute, Mougins Sophia-Antipolis, Mougins Cedex, France.,Department of Urology and Andrology, François-Mitterrand University Hospital, Dijon, France
| | - Florian Bardet
- Department of Urology and Andrology, François-Mitterrand University Hospital, Dijon, France
| | - Paul-Michael Walker
- Department of Spectroscopy and Nuclear Magnetic Resonance, François-Mitterrand University Hospital, Dijon, France.,ImViA Laboratory, EA-7535, Training and Research Unit in Health Sciences, University of Bourgogne/Franche-Comté, Dijon, France
| | | | - Alexandre Cochet
- Department of Spectroscopy and Nuclear Magnetic Resonance, François-Mitterrand University Hospital, Dijon, France.,ImViA Laboratory, EA-7535, Training and Research Unit in Health Sciences, University of Bourgogne/Franche-Comté, Dijon, France
| | - Luc Cormier
- Department of Urology and Andrology, François-Mitterrand University Hospital, Dijon, France
| | - Imad Bentellis
- Department of Urology and Andrology, Sophia Antipolis University Hospital, Nice, France
| | - Romaric Loffroy
- ImViA Laboratory, EA-7535, Training and Research Unit in Health Sciences, University of Bourgogne/Franche-Comté, Dijon, France.,Department of Radiology and Medical Imaging, François-Mitterrand University Hospital, Dijon, France
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20
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Naito H, Kato T, Ishikawa R, Tanaka K, Ueda N, Matsuoka Y, Miyauchi Y, Taoka R, Tsunemori H, Haba R, Nishiyama Y, Sugimoto M, Kakehi Y. The Impact of Histopathological Features of Prostate Cancerous Lesions on Multiparametric Magnetic Resonance Imaging Findings using PI-RADS Version 2. Urology 2020; 149:174-180. [PMID: 33285212 DOI: 10.1016/j.urology.2020.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the square measure threshold of prostate cancer lesions in pathological specimens showing PI-RADS categories 3 to 5, and to identify the pathological characteristics of cancerous lesions over the threshold. METHODS Cancer foci detected in horizontal sections of specimens were defined as pathological cancerous lesions, in which square measure, lesion location (peripheral or transition zone), Gleason pattern (GP), GP4-5 component percentages, and GP 4 subtypes were assessed. A receiver operating characteristic curve was used to determine the threshold of the square measure of pathological specimens that distinguishes between lesions of PI-RADS categories 1 and 2 and those of 3 to 5. Univariable and multivariable analyses were performed to determine the histopathological features associated with PI-RADS categories 3 to 5. RESULTS A total of 100 consecutive patients underwent multiparametric magnetic resonance imaging before robotic-assisted laparoscopic prostatectomy. A total of 1366 pathological cancerous lesions were detected, 217 of which were classified as PI-RADS categories 3 to 5. A square measure of 40 mm2 on pathological specimens was the threshold for PI-RADS categories 3 to 5. Of the 415 lesions that were over 40 mm2, 211 lesions exhibited PI-RADS categories 1, 2 and 204 lesions exhibited PI-RADS categories 3 to 5. Multiple logistic regression analysis showed that square measure, fused glands, and cribriform glands were independently associated with PI-RADS categories 3 to 5. CONCLUSION Cancerous lesions over 40 mm2 showing PI-RADS categories 3 to 5 are associated with square measure, fused glands, and cribriform glands.
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Affiliation(s)
- Hirohito Naito
- Department of Urology, Faculty of Medicine, Kagawa University, Japan
| | - Takuma Kato
- Department of Urology, Faculty of Medicine, Kagawa University, Japan.
| | - Ryou Ishikawa
- Department of Diagnostic Pathology, Kagawa University Hospital, Japan
| | - Kenichi Tanaka
- Department of Radiology, Faculty of Medicine, Kagawa University, Japan
| | - Nobufumi Ueda
- Department of Urology, Faculty of Medicine, Kagawa University, Japan
| | - Yuki Matsuoka
- Department of Urology, Faculty of Medicine, Kagawa University, Japan
| | - Yasuyuki Miyauchi
- Department of Urology, Faculty of Medicine, Kagawa University, Japan
| | - Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Japan
| | | | - Reiji Haba
- Department of Diagnostic Pathology, Kagawa University Hospital, Japan
| | | | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Japan
| | - Yoshiyuki Kakehi
- Department of Urology, Faculty of Medicine, Kagawa University, Japan
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21
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Ahmed AF, El-Helaly H, Elawady S, Elzayat T, Abdelhamid G, Agha MM, Fahim A. Feasibility of multi-parametric magnetic resonance imaging in detection and local staging of prostatic carcinoma. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00033-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Lee CH, Taupitz M, Asbach P, Lenk J, Haas M. Clinical utility of combined T2-weighted imaging and T2-mapping in the detection of prostate cancer: a multi-observer study. Quant Imaging Med Surg 2020; 10:1811-1822. [PMID: 32879859 DOI: 10.21037/qims-20-222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background To evaluate the clinical utility of combined T2-weighted imaging and T2-mapping for the detection of prostate cancer. Methods Forty patients underwent multiparametric magnetic resonance imaging (mpMRI) and T2-mapping of the prostate. Three readers each reviewed two sets of images: T2-weighted fast spin-echo (FSE) sequence (standard T2), and standard T2 in combination with T2-mapping. Each reader assigned probability scores for malignancy to each zone [peripheral zone (PZ) or transition zone (TZ)]. Inter-observer variability for standard T2 and combined standard T2 with T2-mapping were assessed. Diagnostic accuracy was compared between standard T2 and combined standard T2 with T2-mapping. Results There was fair agreement between all three readers for standard T2 [intraclass correlation coefficient (ICC) =0.56] and combined standard T2 with T2-mapping (ICC =0.58). There was no significant difference in the area under the receiver operator characteristics curve for standard T2 compared to combined standard T2 with T2-mapping (0.89 vs. 0.82, P=0.31). Sensitivity (Sn) for combined standard T2 with T2-mapping was significantly higher compared to standard T2 alone (73.0% vs. 49.2%, P=0.006). Specificity (Sp) for combined standard T2 with T2-mapping was borderline significantly lower compared to standard T2 alone (89.3% vs. 94.9%, P=0.05). There was no significant differences between the negative predictive values (NPVs) and positive predictive values (PPVs) (P=0.07, P=0.45). Conclusions Combination of T2-weighted imaging and T2-mapping could potentially increase Sn for prostate malignancy compared to T2-weighted imaging alone.
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Affiliation(s)
- Chau Hung Lee
- Department of Radiology, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Matthias Taupitz
- Department of Radiology, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julian Lenk
- Department of Radiology, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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23
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Alshehri SZ, Alshahrani OS, Almsaoud NA, Al-Ghamdi MA, Alqahtani AM, Almurayyi MM, Autwdi AS, Al-Ghamdi SA, Zogan MM, Alamri AM. The role of multiparametric magnetic resonance imaging and magnetic resonance-guided biopsy in active surveillance for low-risk prostate cancer: A systematic review. Ann Med Surg (Lond) 2020; 57:171-178. [PMID: 32774849 PMCID: PMC7398967 DOI: 10.1016/j.amsu.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/11/2020] [Accepted: 07/11/2020] [Indexed: 11/29/2022] Open
Abstract
The performance of multiparametric magnetic resonance imaging (mpMRI) and subsequent biopsy in monitoring prostate cancer in men on active surveillance (AS) have not been defined clearly. In this systematic review, we aimed to review current literature about the usage of MRI examination in men with low-risk prostate cancer during active surveillance. For that, we searched seven databases to include all studies reporting magnetic resonance imaging in the AS of low-risk prostate cancer. We finally included 11 studies with 1237 patients included. Our results showed an adequate sensitivity and specificity of both modalities to detect disease progression; including disease upgrading and upstaging. However, the performance in the prediction of unfavorable disease was inferior to the detection of upgrading and upstaging. In terms of MRGB, the previous literature agreed on the superiority of using a combination of different biopsy schemes to get a better progression section. Noteworthy, mp-MRI and MRGB had a good predictive value limited to the first year, with TRUSGB showing a superior role in detecting patients with a GS ≥ 7, after that. In conclusion, both of mpMRI and MRGB have shown an adequate performance on assessing disease progression in the AS of low-risk prostate cancer patients. They can be used for disease staging and grading for successful treatment planning. In comparison to the literature, few papers discuss the benefit of MRI screening in low-risk prostate cancer groups. Biopsy is considered more invasive than MRI, thus reducing the burden of such methods on the patients. PSA values can be misinterpreted especially that it can rise in other diseases such as Benign Prostatic Hyperplasia.
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Affiliation(s)
- Sultan Zaher Alshehri
- Department of Urology, Aseer Central Hospital, Abha, Saudi Arabia
- Corresponding author. Department of Urology, Aseer Central Hospital, Al Rabwah, 7663, Abha, Saudi Arabia.
| | - Omar Safar Alshahrani
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Nazal Ahmed Almsaoud
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | | | | | | | - Ali Salem Autwdi
- Department of Urology, King Fahad Central Hospital, Jazan, Saudi Arabia
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24
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Di Trapani E, Musi G, Ferro M, Cordima G, Mistretta FA, Luzzago S, Bianchi R, Cozzi G, Alessi S, Catellani M, Matei DV, Jereczek-Fossa BA, Petralia G, De Cobelli O. Clinical evaluation and disease management of PI-RADS 3 lesions. Analysis from a single tertiary high-volume center. Scand J Urol 2020; 54:382-386. [PMID: 32772805 DOI: 10.1080/21681805.2020.1798503] [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: 10/23/2022]
Abstract
OBJECTIVE To evaluate the clinical and pathological implications of Prostate Cancer (PCa) patients with a Prostate Imaging - Reporting and Data System (PI-RADS) 3 lesion at multi parametric magnetic resonance imaging (mpMRI). METHODS We included 356 patients with a PI-RADS score 3 lesion at mpMRI who underwent prostate biopsy for a suspect of PCa at a single tertiary high-volume centre between 2013 and 2016.We developed Uni- (UVA) and multi variable (MVA) logistic regression analyses assessing the predictors of three endpoints: 1) diagnosis of PCa, 2) active surveillance (AS) criteria and 3) clinically significant (CS) PCa at final pathology. RESULTS PCa was diagnosed in 285 patients (80%), out of these 154 (56%) were eligible for AS according to Prostate Cancer Research International Active Surveillance (PRIAS) criteria. Over the 228 (64%) patients who underwent surgery, 93 (40.8%) had a CS disease at final pathology. Hundred and ninety-three (84.6%) had a pT2 disease and 35 (15.4%) had a pT3 disease. The size of the main lesion, age, PSA and prostate volume efficiently predicted PCa at MVA (all p < 0.05). None of our predictors were significantly associated with AS characteristics. Over those patients who underwent surgery, the biopsy Gleason Score (p = 0.007) efficiently predicted a CS PCa at final pathology. CONCLUSIONS mpMRI-detected PI-RADS 3 lesions should be sent to a prostate biopsy if other clinical parameters suggest the presence of a PCa. In case of diagnosis of a PCa, patients should undergo confirmatory biopsy before being included in AS protocols to avoid underestimation of a CS disease.
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Affiliation(s)
- Ettore Di Trapani
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giovanni Cordima
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Stefano Luzzago
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Bianchi
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gabriele Cozzi
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Sarah Alessi
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, IRCCS, Milan, Italy
| | - Michele Catellani
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Deliu Victor Matei
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Giuseppe Petralia
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
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25
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Panebianco V, Pecoraro M, Fiscon G, Paci P, Farina L, Catalano C. Prostate cancer screening research can benefit from network medicine: an emerging awareness. NPJ Syst Biol Appl 2020; 6:13. [PMID: 32382028 PMCID: PMC7206063 DOI: 10.1038/s41540-020-0133-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/09/2020] [Indexed: 01/03/2023] Open
Abstract
Up to date, screening for prostate cancer (PCa) remains one of the most appealing but also a very controversial topics in the urological community. PCa is the second most common cancer in men worldwide and it is universally acknowledged as a complex disease, with a multi-factorial etiology. The pathway of PCa diagnosis has changed dramatically in the last few years, with the multiparametric magnetic resonance (mpMRI) playing a starring role with the introduction of the “MRI Pathway”. In this scenario the basic tenet of network medicine (NM) that sees the disease as perturbation of a network of interconnected molecules and pathways, seems to fit perfectly with the challenges that PCa early detection must face to advance towards a more reliable technique. Integration of tests on body fluids, tissue samples, grading/staging classification, physiological parameters, MR multiparametric imaging and molecular profiling technologies must be integrated in a broader vision of “disease” and its complexity with a focus on early signs. PCa screening research can greatly benefit from NM vision since it provides a sound interpretation of data and a common language, facilitating exchange of ideas between clinicians and data analysts for exploring new research pathways in a rational, highly reliable, and reproducible way.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I of Rome, Rome, Italy.
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I of Rome, Rome, Italy
| | - Giulia Fiscon
- Institute for System Analysis and Computer Science (IASI), National Research Council, Rome, Italy
| | - Paola Paci
- Institute for System Analysis and Computer Science (IASI), National Research Council, Rome, Italy
| | - Lorenzo Farina
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I of Rome, Rome, Italy
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26
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Onwuharine EN, Clark AJ. Comparison of double inversion recovery magnetic resonance imaging (DIR-MRI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in detection of prostate cancer: A pilot study. Radiography (Lond) 2020; 26:234-239. [PMID: 32052752 DOI: 10.1016/j.radi.2019.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION DCE-MRI is established for detecting prostate cancer (PCa). However, it requires a gadolinium contrast agent, with potential risks for patients. The application of DIR-MRI is simple and may allow cancer detection without the use of an intravenous contrast agent by differentially nullifying signal from normal and abnormal prostate tissue, creating contrast between the cancer and background normal prostate. In this pilot study we gathered data from DIR-MRI and DCE-MRI of the prostate for an equivalence trial. We also looked at how the DIR-MRI appearance varies with the aggressiveness of PCa. METHOD DIR-MRI and DCE-MRI were acquired. The images were assessed by an experienced Consultant Radiologist and a novice reporter (Radiographer). The potential PCa lesions were quantified using a lesion to normal ratio (LNR). Radiological pathological correlation was made to identify the MRI lesions that represented significant PCa. A Wilcoxon sign rank was used to compare DCE-LNR and DIR-LNR for PCa containing lesions. Pearson's correlation was used to look at the relationship between DIR-LNR and PCa grade group (aggressiveness). RESULTS DCE-LNR and DIR-LNR were found to be significantly different (Z = -5.910, p < 0.001). However, a significant correlation was found between PCa grade group and DIR-LNR. CONCLUSION DIR and DCE sequences are not equivalent and significant cancer is more conspicuous on the DCE sequence. However, DIR-LNR does correlate with PCa aggressiveness. IMPLICATIONS FOR PRACTICE With the correlation of PCa grade group with DIR-LNR this may be a useful sequence in evaluation of the prostate; stratifying the risk of there being clinically significant PCa before biopsy is performed. Furthermore, given that DIR-LNR appears to predict PCa aggressiveness DIR might be used as part of a multiparametric MRI protocol designed to avoid biopsy.
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Affiliation(s)
- E N Onwuharine
- Radiology Department, University Hospitals of North Midlands (UHNM) NHS Trust, UK.
| | - A J Clark
- Radiology Department, University Hospitals of North Midlands (UHNM) NHS Trust, UK.
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27
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Wang J, Ni J, Beretov J, Thompson J, Graham P, Li Y. Exosomal microRNAs as liquid biopsy biomarkers in prostate cancer. Crit Rev Oncol Hematol 2019; 145:102860. [PMID: 31874447 DOI: 10.1016/j.critrevonc.2019.102860] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 12/21/2022] Open
Abstract
Prostate cancer (PCa) is the most commonly diagnosed solid-organ cancer in males. The PSA testing may cause overdiagnosis and overtreatment for PCa patients. There is an urgent need for new biomarkers with greater discriminative precision for diagnosis and risk-stratification, to select for prostate biopsy and treatment of PCa. Liquid biopsy is a promising field with the potential to provide comprehensive information on the genetic landscape at diagnosis and to track genomic evolution over time in order to tailor the therapeutic choices at all stages of PCa. Exosomes, containing RNAs, DNAs and proteins, have been shown to be involved in tumour progression and a rich potential source of tumour biomarkers, especially for profiling analysis of their miRNAs content. In this review, we summarise the exosomal miRNAs in PCa diagnosis, prognosis and management, and further discuss their possible technical challenges associated with isolating PCa-specific exosomes.
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Affiliation(s)
- Jingpu Wang
- St George and Sutherland Clinical School, Faculty of Medicine, UNSW Sydney, NSW, Australia; Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia
| | - Jie Ni
- St George and Sutherland Clinical School, Faculty of Medicine, UNSW Sydney, NSW, Australia; Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia
| | - Julia Beretov
- St George and Sutherland Clinical School, Faculty of Medicine, UNSW Sydney, NSW, Australia; Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia; Anatomical Pathology, NSW Health Pathology, St. George Hospital, Kogarah, NSW, Australia
| | - James Thompson
- St George and Sutherland Clinical School, Faculty of Medicine, UNSW Sydney, NSW, Australia; Department of Urology, St. George Hospital, Kogarah, NSW, Australia; Prostate Clinical Research Group, Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - Peter Graham
- St George and Sutherland Clinical School, Faculty of Medicine, UNSW Sydney, NSW, Australia; Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia
| | - Yong Li
- St George and Sutherland Clinical School, Faculty of Medicine, UNSW Sydney, NSW, Australia; Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia; School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China.
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28
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England T, Li J, Cohen RJ. Fifteen-year analysis of prostate biopsies in Western Australia including recent impact of multiparametric magnetic resonance imaging. ANZ J Surg 2019; 89:1605-1609. [PMID: 31769189 DOI: 10.1111/ans.15566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The number of men undergoing prostate biopsy and subsequent cancer detection rates has changed significantly over the past 15 years. We aim to evaluate changes in the diagnostic pathway of prostate cancer between 2003 and 2018. METHODS A total of 13 844 Western Australian biopsy-naive men were assessed to determine trends in age, prostate-specific antigen levels, number of core samples, positive cores and tumour grade (Gleason) between 2003 and 2018. Further, in 2018, the impact of pre-biopsy multiparametric magnetic resonance imaging (mpMRI) was also assessed. RESULTS Between 2003 and 2012, the number of men undergoing biopsy increased from 1445 to 3100. During this time, the prostate cancer detection rate (%) remained unchanged. However, in 2018, 2042 men underwent prostate biopsy (reduction of 34.1%) and the detection rate increased to 72.6%. The incidence of low-grade cancer (Gleason score <7) increased from 28.1% in 2003 to 36.2% in 2012, but it decreased significantly to 15.1% by 2018. High-grade cancer (Gleason score >7) declined from 21.3% in 2003 to 15.2% in 2012 but then increased to 35.7% in 2018. The use of mpMRI in 2018 improved the detection rate of high-grade cancer. However, its specificity remains low (29.7%) and a considerable proportion of low Prostate Imaging Reporting and Data System score lesions was later diagnosed with cancer unsuitable for active surveillance. CONCLUSION In recent years, there has been a significant increase in the diagnosis high-grade cancer and a reduction in cancer suitable for active surveillance. mpMRI identifies high-grade tumours but is not a reliable alternative to prostate biopsy.
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Affiliation(s)
- Thomas England
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Jian Li
- Uropath Pty Ltd, Perth, Western Australia, Australia
| | - Ronald J Cohen
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Uropath Pty Ltd, Perth, Western Australia, Australia
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29
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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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30
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Martorana E, Pirola GM, Aisa MC, Scialpi P, Di Blasi A, Saredi G, D'Andrea A, Signore S, Grisanti R, Scialpi M. Prostate MRI and transperineal TRUS/MRI fusion biopsy for prostate cancer detection: clinical practice updates. Turk J Urol 2019; 45:237-244. [PMID: 31291186 DOI: 10.5152/tud.2019.19106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 11/22/2022]
Abstract
This narrative review summarizes the current knowledge about multiparametric and biparametric magnetic resonance imaging of the prostate. This is provided from both a radiological and a urological point of view analyzing the technical aspects of fusion-targeted biopsy using the transperineal approach. We report practical considerations concerning pure cognitive and software-assisted settings, discuss the principal transperineal fusion software now available, and debate the pros and cons of choosing one approach over the other.
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Affiliation(s)
| | | | - Maria Cristina Aisa
- Division of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Pietro Scialpi
- Department of Urology, Portogruaro Hospital, Portogruaro, Italy
| | - Aldo Di Blasi
- Section of Radiology and Diagnostic Imaging, Tivoli Hospital, Lazio, Italy
| | | | | | | | | | - Michele Scialpi
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, University of Perugia, Italy
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Schlenker B, Apfelbeck M, Armbruster M, Chaloupka M, Stief CG, Clevert DA. Comparison of PIRADS 3 lesions with histopathological findings after MRI-fusion targeted biopsy of the prostate in a real world-setting. Clin Hemorheol Microcirc 2019; 71:165-170. [PMID: 30562897 DOI: 10.3233/ch-189407] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION We aimed to evaluate whether PIRADS 3 lesions in multiparametric MRI (mpMRI) represent a significant risk of prostate cancer (PCa) in a real-world setting of different referring radiologic institutes. MATERIALS AND METHODS Between May 2015 and October 2017, a total of 408 patients were referred to our clinic for MRI-ultrasound fusion targeted biopsy of the prostate (FusPbx) due to suspected prostate cancer. In all patients, preoperatively an mpMRI of the prostate was performed by altogether 62 different radiologic institutes. Prostate lesions were classified according to the PIRADS system. A PIRADS 3 lesion was diagnosed in 41 patients. FusPbx was performed transrectally using a Philips EPIQ 7 (Philips Medical Systems, Bothell, WA) scanner with plane wise fusion of ultrasound and MRI image data. In addition to FusPbx in each patient a randomized 12-core transrectal ultrasound guided biopsy (USPbx) was performed. RESULTS Mean PSA Level was 9.5 ng/ml (range: 1- 26 ng/ml), mean patients age was 66.1 years (48.6- 80.4). In 11/41 patients (26.8%) prostate cancer was diagnosed by FusPbx of the PIRADS 3 lesion. In the target lesion PCa was classified as Gleason Score 3+3 in 5 patients, as 3+4 in 3, 4+3 in 1, 4+4 in 1 and 4+5 in 1 patient. In patients with negative FusPbx USPbx revealed PCa in another 7 patients (17.1%). In 5 of these GS 3+3 PCa was found, in another 2 patients GS 3+4 PCa. CONCLUSIONS PIRADS 3 lesion indicates an equivocal likelihood of significant prostate cancer. In our series the overall PCa detection rate was 26.8% and 14.6% for clinically significant cancer in PIRADS 3 lesions. This evokes the question, if PIRADS 3 lesions could be surveilled only. The findings should be confirmed in a larger series.
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Affiliation(s)
- B Schlenker
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - M Apfelbeck
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - M Armbruster
- Department of Clinical Radiology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - M Chaloupka
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - C G Stief
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - D-A Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
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Kayano PP, Carneiro A, Castilho TML, Sivaraman A, Claros OR, Baroni RH, Garcia RG, Mariotti GC, Smaletz O, Filippi RZ, Lemos GC. Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer. Int Braz J Urol 2019; 44:1106-1113. [PMID: 30325600 PMCID: PMC6442175 DOI: 10.1590/s1677-5538.ibju.2017.0552] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 08/05/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy (FB) improves the detection of clinically significant prostate cancer (PCa). We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for PCa. MATERIALS AND METHODS A retrospective analysis of data that were collected prospectively from January 2011 to June 2016 from patients who underwent prostate biopsy and subsequent radical prostatectomy. The study cohort was divided into two groups: US-MRI FB (Group A) and TRUS SRB (Group B). US-MRI FB was performed in patients with a previous MRI with a focal lesion with a Likert score ≥3; otherwise, a TRUS SRB was performed. RESULTS In total, 73 men underwent US-MRI FB, and 89 underwent TRUS SRB. The GU rate was higher in Group B (31.5% vs. 16.4%; p=0.027). According to the Gleason grade pattern, GU was higher in Group B than in Group A (40.4% vs. 23.3%; p=0.020). Analyses of the Gleason grading patterns showed that Gleason scores 3+4 presented less GU in Group A (24.1% vs. 52.6%; p=0.043). The Bland-Altman plot analysis showed a higher bias in Group B than in Group A (-0.27 [-1.40 to 0.86] vs. -0.01 [-1.42 to 1.39]). In the multivariable logistic regression analysis, the only independent predictor of GU was the use of TRUS SRB (2.64 [1.11 - 6.28]; p=0.024). CONCLUSIONS US-MRI FB appears to be related to a decrease in GU rate and an increase in concordance between biopsy and final pathology compared to TRUS SRB, suggesting that performing US-MRI FB leads to greater accuracy of diagnosis and better treatment decisions.
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Affiliation(s)
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Arjun Sivaraman
- Memorial Sloan Kettering Cancer Center - USA, New York, NY, EUA
| | | | | | | | | | - Oren Smaletz
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Sun Y, Reynolds HM, Parameswaran B, Wraith D, Finnegan ME, Williams S, Haworth A. Multiparametric MRI and radiomics in prostate cancer: a review. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:3-25. [PMID: 30762223 DOI: 10.1007/s13246-019-00730-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/22/2019] [Indexed: 12/30/2022]
Abstract
Multiparametric MRI (mpMRI) is an imaging modality that combines anatomical MR imaging with one or more functional MRI sequences. It has become a versatile tool for detecting and characterising prostate cancer (PCa). The traditional role of mpMRI was confined to PCa staging, but due to the advanced imaging techniques, its role has expanded to various stages in clinical practises including tumour detection, disease monitor during active surveillance and sequential imaging for patient follow-up. Meanwhile, with the growing speed of data generation and the increasing volume of imaging data, it is highly demanded to apply computerised methods to process mpMRI data and extract useful information. Hence quantitative analysis for imaging data using radiomics has become an emerging paradigm. The application of radiomics approaches in prostate cancer has not only enabled automatic localisation of the disease but also provided a non-invasive solution to assess tumour biology (e.g. aggressiveness and the presence of hypoxia). This article reviews mpMRI and its expanding role in PCa detection, staging and patient management. Following that, an overview of prostate radiomics will be provided, with a special focus on its current applications as well as its future directions.
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Affiliation(s)
- Yu Sun
- University of Sydney, Sydney, Australia. .,Peter MacCallum Cancer Centre, Melbourne, Australia.
| | | | | | - Darren Wraith
- Queensland University of Technology, Brisbane, Australia
| | - Mary E Finnegan
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
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Jensen C, Carl J, Boesen L, Langkilde NC, Østergaard LR. Assessment of prostate cancer prognostic Gleason grade group using zonal-specific features extracted from biparametric MRI using a KNN classifier. J Appl Clin Med Phys 2019; 20:146-153. [PMID: 30712281 PMCID: PMC6370983 DOI: 10.1002/acm2.12542] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/27/2018] [Accepted: 01/11/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose To automatically assess the aggressiveness of prostate cancer (PCa) lesions using zonal‐specific image features extracted from diffusion weighted imaging (DWI) and T2W MRI. Methods Region of interest was extracted from DWI (peripheral zone) and T2W MRI (transitional zone and anterior fibromuscular stroma) around the center of 112 PCa lesions from 99 patients. Image histogram and texture features, 38 in total, were used together with a k‐nearest neighbor classifier to classify lesions into their respective prognostic Grade Group (GG) (proposed by the International Society of Urological Pathology 2014 consensus conference). A semi‐exhaustive feature search was performed (1–6 features in each feature set) and validated using threefold stratified cross validation in a one‐versus‐rest classification setup. Results Classifying PCa lesions into GGs resulted in AUC of 0.87, 0.88, 0.96, 0.98, and 0.91 for GG1, GG2, GG1 + 2, GG3, and GG4 + 5 for the peripheral zone, respectively. The results for transitional zone and anterior fibromuscular stroma were AUC of 0.85, 0.89, 0.83, 0.94, and 0.86 for GG1, GG2, GG1 + 2, GG3, and GG4 + 5, respectively. CONCLUSION This study showed promising results with reasonable AUC values for classification of all GG indicating that zonal‐specific imaging features from DWI and T2W MRI can be used to differentiate between PCa lesions of various aggressiveness.
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Affiliation(s)
- Carina Jensen
- Department of Medical Physics, Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Carl
- Department of Oncology, Naestved Sygehus, Zealand University Hospital, Roskilde, Denmark
| | - Lars Boesen
- Department of Urology, Herlev Gentofte University Hospital, Herlev, Denmark
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35
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Sabouri S, Chang SD, Goldenberg SL, Savdie R, Jones EC, Black PC, Fazli L, Kozlowski P. Comparing diagnostic accuracy of luminal water imaging with diffusion-weighted and dynamic contrast-enhanced MRI in prostate cancer: A quantitative MRI study. NMR IN BIOMEDICINE 2019; 32:e4048. [PMID: 30575145 DOI: 10.1002/nbm.4048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Luminal water imaging (LWI) is a new MRI T2 mapping technique that has been developed with the aim of diagnosis of prostate carcinoma (PCa). This technique measures the fractional amount of luminal water in prostate tissue, and has shown promising preliminary results in detection of PCa. To include LWI in clinical settings, further investigation on the accuracy of this technique is required. In this study, we compare the diagnostic accuracy of LWI with those of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI in detection and grading of PCa. Fifteen patients with biopsy-proven PCa consented to participate in this ethics-board-approved prospective study. Patients were examined with LWI, DWI, and DCE sequences at 3 T prior to radical prostatectomy. Maps of MRI parameters were generated and registered to whole-mount histology. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of individual and combined MR parameters. Correlation with Gleason score (GS) was evaluated using Spearman's rank correlation test. The results show that area under the ROC curve (AUC) obtained from LWI was equal to or higher than the AUC obtained from DWI, DCE, or their combination, in peripheral zone (0.98 versus 0.90, 0.89, and 0.91 respectively), transition zone (0.99 versus 0.98, n/a, and 0.98), and the entire prostate (0.85 versus 0.81, 0.75, and 0.84). The strongest correlation with GS was achieved from LWI (ρ = -0.81 ± 0.09, P < 0.001). Results of this pilot study show that LWI performs equally well as, or better than, DWI and DCE in detection of PCa. LWI provides significantly higher correlation with GS than DWI and DCE. This technique can potentially be included in clinical MRI protocols to improve characterization of tumors. However, considering the small size of the patient population in this study, a further study with a larger cohort of patients and broader range of GS is required to confirm the findings and draw a firm conclusion on the applicability of LWI in clinical settings.
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Affiliation(s)
| | - Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | - S Larry Goldenberg
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Richard Savdie
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Edward C Jones
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Ladan Fazli
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Piotr Kozlowski
- UBC MRI Research Center, Vancouver, BC, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Vancouver Prostate Centre, Vancouver, BC, Canada
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Campa R, Del Monte M, Barchetti G, Pecoraro M, Salvo V, Ceravolo I, Indino EL, Ciardi A, Catalano C, Panebianco V. Improvement of prostate cancer detection combining a computer-aided diagnostic system with TRUS-MRI targeted biopsy. Abdom Radiol (NY) 2019; 44:264-271. [PMID: 30054684 DOI: 10.1007/s00261-018-1712-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To validate a novel consensus method, called target-in-target, combining human analysis of mpMRI with automated CAD system analysis, with the aim to increasing the prostate cancer detection rate of targeted biopsies. METHODS A cohort of 420 patients was enrolled and 253 patients were rolled out, due to exclusion criteria. 167 patients, underwent diagnostic 3T MpMRI. Two expert radiologists evaluated the exams adopting PI-RADSv2 and CAD system. When a CAD target overlapped with a radiologic one, we performed the biopsy in the overlapping area which we defined as target-in-target. Targeted TRUS-MRI fusion biopsy was performed in 63 patients with a total of 212 targets. The MRI data of all targets were quantitatively analyzed, and diagnostic findings were compared to pathologist's biopsy reports. RESULTS CAD system diagnostic performance exhibited sensitivity and specificity scores of 55.2% and 74.1% [AUC = 0.63 (0.54 ÷ 0.71)] , respectively. Human readers achieved an AUC value, in ROC analysis, of 0.71 (0.63 ÷ 0.79). The target-in-target method provided a detection rate per targeted biopsy core of 81.8 % vs. a detection rate per targeted biopsy core of 68.6 % for pure PI-RADS based on target definitions. The higher per-core detection rate of the target-in-target approach was achieved irrespective of the presence of technical flaws and artifacts. CONCLUSIONS A novel consensus method combining human reader evaluation with automated CAD system analysis of mpMRI to define prostate biopsy targets was shown to improve the detection rate per biopsy core of TRUS-MRI fusion biopsies. Results suggest that the combination of CAD system analysis and human reader evaluation is a winning strategy to improve targeted biopsy efficiency.
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Affiliation(s)
- Riccardo Campa
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Maurizio Del Monte
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Giovanni Barchetti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Vincenzo Salvo
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Isabella Ceravolo
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Elena Lucia Indino
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Antonio Ciardi
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, V.le Regina Elena, 324, 00161, Rome, Italy.
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Comparison of T2-Weighted Imaging, DWI, and Dynamic Contrast-Enhanced MRI for Calculation of Prostate Cancer Index Lesion Volume: Correlation With Whole-Mount Pathology. AJR Am J Roentgenol 2018; 212:351-356. [PMID: 30540213 DOI: 10.2214/ajr.18.20147] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective of our study was to investigate the comparative effectiveness of different MRI sequences for the estimation of index lesion volume in patients with prostate cancer (PCa) compared with ground truth volume measured on whole-mount pathology. MATERIALS AND METHODS Patients with PCa underwent multiparametric MRI (mpMRI) on a 3-T MRI scanner before radical prostatectomy. Forty PCa index lesions were identified and outlined on histology by a pathologist. Two radiologists who were informed about the presence of PCa but were not aware of lesion outlines on histology worked in consensus to delineate PCa lesions on T2-weighted imaging, apparent diffusion coefficient (ADC) maps, and early-phase dynamic contrast-enhanced MRI (DCE-MRI). The lesion volumes from different mpMRI sequences and the percentage of volume underestimation compared with pathology were calculated and correlated with volume at pathology. The repeated-measures ANOVA with the posthoc Bonferroni test was performed to evaluate whether the difference between the estimated tumor volumes was statistically significant. RESULTS The mean PCa lesion volume estimated from pathology, T2-weighted imaging, DWI (ADC maps), and DCE-MRI were 4.61 ± 4.99 (SD) cm3, 2.03 ± 2.96 cm3, 1.81 ± 2.76 cm3, and 3.48 ± 4.06 cm3, respectively. The lesion volumes on T2-weighted images (p = 0.000002), ADC maps (p = 0.000003), and DCE-MR images (p = 0.004412) were significantly lower than those from pathology. PCa lesion volume was significantly underestimated on T2-weighted images, ADC maps, and DCE-MR images compared with pathology by 54.98% ± 22.60% (mean ± SD), 58.59% ± 18.58%, and 18.33% ± 30.11%, respectively; underestimation using T2-weighted imaging (p = 1.01 × 10-11) and DWI (p = 2.94 × 10-11) was significantly higher than underestimation using DCE-MRI. Correlations between lesion volume estimated on T2-weighted images, ADC maps, and DCE-MR images with pathology were 0.91 (p = 9.03 × 10-16), 0.86 (p = 7.32 × 10-13), and 0.93 (p = 8.22 × 10-18), respectively. CONCLUSION DCE-MRI performed better than T2-weighted imaging and DWI for estimation of index PCa volume and therefore can be preferred over these other two sequences for volume estimation.
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Tkac J, Bertok T, Hires M, Jane E, Lorencova L, Kasak P. Glycomics of prostate cancer: updates. Expert Rev Proteomics 2018; 16:65-76. [PMID: 30451032 DOI: 10.1080/14789450.2019.1549993] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Prostate cancer (PCa) is a life-threatening disease affecting millions of men. The current best PCa biomarker (level of prostate-specific antigen in serum) lacks specificity for PCa diagnostics and this is why novel PCa biomarkers in addition to the conventional ones based on biomolecules such as DNA, RNA and proteins need to be identified. Areas covered: This review details the potential of glycans-based biomarkers to become diagnostic, prognostic, predictive and therapeutic PCa biomarkers with a brief description of the innovative approaches applied to glycan analysis to date. Finally, the review covers the possibility to use exosomes as a rich source of glycans for future innovative and advanced diagnostics of PCa. The review covers updates in the field since 2016. Expert commentary: The summary provided in this review paper suggests that glycan-based biomarkers can offer high-assay accuracy not only for diagnostic purposes but also for monitoring/surveillance of the PCa disease.
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Affiliation(s)
- Jan Tkac
- a Slovak Academy of Sciences , Institute of Chemistry , Bratislava , Slovakia.,b Glycanostics Ltd ., Bratislava , Slovakia
| | - Tomas Bertok
- a Slovak Academy of Sciences , Institute of Chemistry , Bratislava , Slovakia.,b Glycanostics Ltd ., Bratislava , Slovakia
| | - Michal Hires
- a Slovak Academy of Sciences , Institute of Chemistry , Bratislava , Slovakia
| | - Eduard Jane
- a Slovak Academy of Sciences , Institute of Chemistry , Bratislava , Slovakia
| | - Lenka Lorencova
- a Slovak Academy of Sciences , Institute of Chemistry , Bratislava , Slovakia.,b Glycanostics Ltd ., Bratislava , Slovakia
| | - Peter Kasak
- c Center for Advanced Materials , Qatar University , Doha , Qatar
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Demirel CH, Altok M, Davis JW. Focal therapy for localized prostate cancer: is there a "middle ground" between active surveillance and definitive treatment? Asian J Androl 2018; 21:240302. [PMID: 30178774 PMCID: PMC6337958 DOI: 10.4103/aja.aja_64_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/12/2018] [Indexed: 01/02/2023] Open
Abstract
In recent years, it has come a long way in the diagnosis, treatment, and follow-up of prostate cancer. Beside this, it was argued that definitive treatments could cause overtreatment, particularly in the very low, low, and favorable risk group. When alternative treatment and follow-up methods are being considered for this group of patients, active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era. However, it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up. In the light of technological developments, the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet. According to the initial results, it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient. Thus, focal therapies have begun to find their "middle ground" place between definitive therapies and active follow-up.
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Affiliation(s)
- Cihan H Demirel
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Muammer Altok
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Song W, Bang SH, Jeon HG, Jeong BC, Seo SI, Jeon SS, Choi HY, Kim CK, Lee HM. Role of PI-RADS Version 2 for Prediction of Upgrading in Biopsy-Proven Prostate Cancer With Gleason Score 6. Clin Genitourin Cancer 2018; 16:281-287. [DOI: 10.1016/j.clgc.2018.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 11/27/2022]
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41
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Sampurno F, Zheng J, Di Stefano L, Millar JL, Foster C, Fuedea F, Higano C, Huland H, Mark S, Moore C, Richardson A, Sullivan F, Wenger NS, Wittmann D, Evans S. Quality Indicators for Global Benchmarking of Localized Prostate Cancer Management. J Urol 2018; 200:319-326. [DOI: 10.1016/j.juro.2018.02.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Fanny Sampurno
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jia Zheng
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lydia Di Stefano
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy L. Millar
- William Buckland Radiotherapy Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Claire Foster
- Faculty of Health Sciences, University of Southampton and University Hospital Southampton, Southampton and Urology, London, United Kingdom
| | - Ferran Fuedea
- Radiation Oncology Department, Institut Català d'Oncologia, Radiation Oncology, Barcelona University and Radiobiology and Cancer Group, Bellvitge Biochemical Research Institute, Barcelona, Spain
| | - Celestia Higano
- Department of Medicine, Division of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Hartwig Huland
- Martini-Klinik, Prostate Cancer Centre, University Hamburg, Hamburg, Germany
| | - Stephen Mark
- Department of Urology, Christchurch Hospital and University of Otago, Christchurch, New Zealand
| | - Caroline Moore
- Division of Surgical and Interventional Science, University College London, London, United Kingdom
| | - Alison Richardson
- Cancer Nursing and End of Life Care, Faculty of Health Sciences, University of Southampton and University Hospital Southampton, Southampton and Urology, London, United Kingdom
| | - Frank Sullivan
- Prostate Cancer Institute, National University of Ireland Galway and Department of Radiation Oncology, Galway Clinic, Galway, Ireland
| | - Neil S. Wenger
- Division of General Internal Medicine, University of California-Los Angeles, Los Angeles, California
| | - Daniela Wittmann
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Lee CH, Ku JY, Park WY, Lee NK, Ha HK. Comparison of the accuracy of multiparametric magnetic resonance imaging (mpMRI) results with the final pathology findings for radical prostatectomy specimens in the detection of prostate cancer. Asia Pac J Clin Oncol 2018; 15:e20-e27. [PMID: 29920966 DOI: 10.1111/ajco.13027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/19/2018] [Indexed: 01/21/2023]
Abstract
AIMS To assess the accuracy of multiparametric magnetic resonance imaging (mpMRI), used in conjunction with the Prostrate Imaging Reporting and Data System (PI-RADS), version 2, in the detection of prostate cancer (PCa), and to determine the extent of the efficacy of mpMRI as a screening test in biopsy-naïve patients. METHODS Retrospective analysis was conducted in 107 patients who underwent mpMRI prior to radical prostatectomy (RP) at a single institution. The mpMRI findings were reassessed using PI-RADS, version 2. A comparison was made between the histological findings for the RP specimens and the mpMRI results. RESULTS Unique histologically confirmed PCa foci (237) were identified in 107 patients. Overall, mpMRI sensitivity of 46% was found for PCa detection (110/237). The sensitivity, specificity and negative predictive value of mpMRI was 75.5%, 77.0% and 79.8%, respectively, for clinically significant cancer, and 75.7%, 77.7% and 79.5%, for pathological index tumors. A moderate and significant correlation was observed between a high PI-RADS score and a high pathological grade, tumor volume, index tumor status and clinically significant cancer status (all, P < 0.001, respectively). Pathological tumor volume was a significant predictor of PCa detection using mpMRI according to multivariate analysis. Using a cut-off value of 0.89 cc, the sensitivity and specificity of mpMRI for PCa detection were 0.87 and 0.65, respectively. CONCLUSION The mpMRI, used in conjunction with PI-RADS, was useful in detecting PCa and in predicting tumor aggressiveness. However, the detection of 20% of clinically significant cancer was missed using mpMRI. Thus, its inclusion in a triage test should be limited to selected biopsy-naïve patients.
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Affiliation(s)
- Chan Ho Lee
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ja Yoon Ku
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Won Young Park
- Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Nam Kyung Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea.,Pusan National University School of Medicine, Biomedical Research Institute, Busan, South Korea
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The role of the multiparametric MRI in the diagnosis of prostate cancer in biopsy-naïve men. Curr Opin Urol 2018; 27:488-494. [PMID: 28562371 DOI: 10.1097/mou.0000000000000415] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW To review the role of prebiopsy multiparametric MRI in biopsy-naïve men for the detection of clinically significant prostate cancer. RECENT FINDINGS Recent level 1 evidence shows that multiparametric MRI has high sensitivity and negative predictive value for the detection of clinically significant prostate cancer in biopsy-naïve men. Concurrent developments include important work in the standardization of MRI reporting. The low specificity and positive predictive value of MRI means that biopsy is still necessary following MRI. MRI-targeted prostate biopsy has emerged as an alternative diagnostic test to transrectal ultrasound guided prostate biopsy, though its exact role in biopsy-naïve men and the optimal technique remain to be defined. SUMMARY There is the potential for MRI to be used as a triage test to allow a proportion of men to avoid biopsy and remain on prostate-specific antigen surveillance. MRI-suspicious areas can be sampled more intensively using MRI-targeted biopsy that can be carried out in a variety of ways. Future work should focus on the cost-effectiveness of introducing a prebiopsy MRI pathway in biopsy-naïve men and addressing the training needs for such a change. VIDEO ABSTRACT: http://links.lww.com/COU/A11.
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Kumar V, Bora GS, Kumar R, Jagannathan NR. Multiparametric (mp) MRI of prostate cancer. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2018; 105:23-40. [PMID: 29548365 DOI: 10.1016/j.pnmrs.2018.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/17/2018] [Accepted: 01/28/2018] [Indexed: 06/08/2023]
Abstract
Prostate cancer (PCa) is one of the most prevalent cancers in men. A large number of men are detected with PCa; however, the clinical behavior ranges from low-grade indolent tumors that never develop into a clinically significant disease to aggressive, invasive tumors that may rapidly progress to metastatic disease. The challenges in clinical management of PCa are at levels of screening, diagnosis, treatment, and follow-up after treatment. Magnetic resonance imaging (MRI) methods have shown a potential role in detection, localization, staging, assessment of aggressiveness, targeting biopsies, etc. in PCa patients. Multiparametric MRI (mpMRI) is emerging as a better option compared to the individual imaging methods used in the evaluation of PCa. There are attempts to improve the reproducibility and reliability of mpMRI by using an objective scoring system proposed in the prostate imaging reporting and data system (PIRADS) for standardized reporting. Prebiopsy mpMRI may be used to detect PCa in men with elevated prostate-specific antigen or abnormal digital rectal examination and to enable targeted biopsies. mpMRI can also be used to decide on clinical management of patients, for example active surveillance, and may help in detecting only the pathology that requires detection. It can potentially not only guide patient selection for initial and repeat biopsy but also reduce false-negative biopsies. This review presents a description of the MR methods most commonly applied for investigations of prostate. The anatomical, functional and metabolic parameters obtained from these MR methods are discussed with regard to their physical basis and their contribution to mpMRI investigations of PCa.
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Affiliation(s)
- Virendra Kumar
- Department of NMR & MRI Facility, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
| | - Girdhar S Bora
- Department of Urology, Post-Graduate Institute of Medical Sciences, Chandigarh 160012, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Naranamangalam R Jagannathan
- Department of NMR & MRI Facility, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Steinkohl F, Gruber L, Bektic J, Nagele U, Aigner F, Herrmann TRW, Rieger M, Junker D. Retrospective analysis of the development of PIRADS 3 lesions over time: when is a follow-up MRI reasonable? World J Urol 2017; 36:367-373. [PMID: 29243110 DOI: 10.1007/s00345-017-2135-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/16/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Often PIRADS 3 findings are usually followed up with further MRIs of the prostate. Current guidelines do not state an optimal interval between the initial MRI and the follow-up MRI. The aim of this study was to find out if PIRADS 3 lesions evolve over time and to determine how long the optimal interval between initial MRI and follow-ups should be. METHODS In this retrospective study, 141 consecutive patients were included who underwent at least one follow-up MRI after an initial PIRADS 3 finding. Changes in PIRADS score and the interval between the first and the follow-up MRI were recorded. An optimal duration was calculated. RESULTS Of all patients, 76.6% had a change from PIRADS 3 to either 2 or 4 in the first follow-up MRI. Reclassifications to PIRADS 4 happened earlier than reclassifications to PIRADS 2 (after 366.5 ± 217.9 days and after 534.2 ± 253.0 days, respectively). An optimal point of time for a follow-up to distinguish between changes to PIRADS 2 versus PIRADS 4 turned out to be 379 days (12.4 months, AUC 0.734, p = 0.0001). Of all patients with a PIRADS 3 lesion 14.8% harboured a prostate carcinoma. CONCLUSION Performing follow-up mpMRI rather than immediate biopsy may be beneficial for patients with PIRADS 3, as most lesions can be reclassified after a manageable period of time. Upgrades to PIRADS 4 seem to happen earlier and within fewer follow-ups than downgrades to PIRADS 2. The optimal interval for follow-up MRIs seems to be 12.4 months.
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Affiliation(s)
- Fabian Steinkohl
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Udo Nagele
- Department of Urology, Landeskrankenhaus Hall in Tirol, Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas R W Herrmann
- Department of Urology, Hannover Medical School, Hannover, Germany.,Department of Urology, Kantonspital Thurgau, Frauenfeld, Switzerland.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Michael Rieger
- Department of Radiology, Landeskrankenhaus Hall in Tirol, Milser Straße 10, 6060, Hall in Tirol, Austria
| | - Daniel Junker
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria. .,Department of Radiology, Landeskrankenhaus Hall in Tirol, Milser Straße 10, 6060, Hall in Tirol, Austria.
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Liu H, Zhou H, Yan L, Ye T, Lu H, Sun X, Ye Z, Xu H. Prognostic significance of six clinicopathological features for biochemical recurrence after radical prostatectomy: a systematic review and meta-analysis. Oncotarget 2017; 9:32238-32249. [PMID: 30181813 PMCID: PMC6114957 DOI: 10.18632/oncotarget.22459] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 10/11/2017] [Indexed: 11/25/2022] Open
Abstract
Identifying patients with high risk of biochemical recurrence after radical prostatectomy is of immense value in clinical practice. Assessment of prognostic significance of specific clinicopathological features plays an important role in surgical management after prostatectomy. The purpose of our meta-analysis was to investigate the association between the six pathological characteristics and the prognosis of prostate cancer. We carried out a systematic document retrieval in electronic databases to sort out appropriate studies. Outcomes of interest were gathered from studies comparing biochemical recurrence-free survival (BCFS) in patients with the six pathological traits. Studies results were pooled, and hazard ratios (HRs) combined with corresponding 95% confidence intervals (CIs) for survival were used to estimate the effect size. 29 studies (21,683 patients) were enrolled in our meta-analysis. All the six predictors were statistically significant for BCFS with regard to seminal vesicle invasion (HR = 1.97, 95% CI = 1.79–2.18, p < 0.00001), positive surgical margin (HR = 1.79, 95% CI = 1.56–2.06, p < 0.00001), extracapsular extension (HR = 2.03, 95% CI = 1.65–2.50, p < 0.0001), lymphovascular invasion (HR = 1.85, 95% CI = 1.54–2.22, p < 0.00001), lymph node involvement (HR = 1.88, 95% CI = 1.37–2.60, p = 0.0001) and perineural invasion (HR = 1.59, 95% CI = 1.33–1.91, p < 0.00001). Subgroup analysis showed that all the six predictors had significantly relationship with poor BCFS. The pooled results demonstrated that the six clinical findings indicated a worse prognosis in patients with prostate cancer. In conclusion, our results show several clinicopathological characteristics can predict the risk of biochemical recurrence after radical prostatectomy. Prospective studies are needed to further confirm the predictive value of these features for the prognosis of prostate cancer patients after radical prostatectomy.
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Affiliation(s)
- Haoran Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hui Zhou
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Libin Yan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tao Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hongyan Lu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xifeng Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Kam J, Yuminaga Y, Kim R, Aluwihare K, Macneil F, Ouyang R, Ruthven S, Louie-Johnsun M. Does magnetic resonance imaging-guided biopsy improve prostate cancer detection? A comparison of systematic, cognitive fusion and ultrasound fusion prostate biopsy. Prostate Int 2017; 6:88-93. [PMID: 30140657 PMCID: PMC6104474 DOI: 10.1016/j.prnil.2017.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/03/2017] [Accepted: 10/25/2017] [Indexed: 02/05/2023] Open
Abstract
Background The increase in the use of multiparametric magnetic resonance imaging for the detection of prostate cancer has led to the rapid adoption of MRI-guided biopsies (MRGBs). To date, there is limited evidence in the use of MRGB and no direct comparisons between the different types of MRGB. We aimed to assess whether multiparametric MRGBs with MRI-US transperineal fusion biopsy (FB) and cognitive biopsy (CB) improved the management of prostate cancer and to assess if there is any difference in prostate cancer detection with FB compared with CB. Methods Patients who underwent an MRGB and a systematic biopsy (SB) from June 2014 to August 2016 on the Central Coast, NSW, Australia, were included in the study. The results of SB were compared with MRGB. The primary outcome was prostate cancer detection and if MRGB changed patient management. Results A total of 121 cases were included with a mean age of 65.5 years and prostate-specific antigen 7.4 ng/mL. Seventy-five cases (62%) had a Prostate Imaging and Reporting Data System 4–5 lesions and 46 (38%) had a Prostate Imaging and Reporting Data System 3 lesions. Fifty-six cases underwent CB and 65 underwent FB. Of the 93 patients with prostate cancer detected, 19 men (20.5%) had their management changed because of the MRGB results. Eight men (9%) had prostate cancer detected on MRGB only and 12 men (13%) underwent radical prostatectomy or radiotherapy based on the MRGB results alone. There was a trend to a higher rate of change in management with FB compared with CB (29% vs. 18%). Conclusions This is one of the first Australian studies to assess the utility of MRGB and compare FB with CB. MRGB is a useful adjunct to SB, changing management in over 20% of our cases, with a trend toward FB having a greater impact on patient management compared with CB.
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Affiliation(s)
- Jonathan Kam
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, Australia
| | - Yuigi Yuminaga
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia
| | - Raymond Kim
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia
| | | | - Finlay Macneil
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, Australia
| | - Rupert Ouyang
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia
| | - Stephen Ruthven
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, Australia
| | - Mark Louie-Johnsun
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, Australia
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Del Monte M, Leonardo C, Salvo V, Grompone MD, Pecoraro M, Stanzione A, Campa R, Vullo F, Sciarra A, Catalano C, Panebianco V. MRI/US fusion-guided biopsy: performing exclusively targeted biopsies for the early detection of prostate cancer. Radiol Med 2017; 123:227-234. [PMID: 29075977 DOI: 10.1007/s11547-017-0825-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/09/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to validate the role of MR/Ultrasound Fusion-Guided Targeted Biopsy as a first diagnostic modality in subjects with clinical suspicion of prostate cancer (PCa). MATERIALS AND METHODS 108 men (age range 46-78 years) with clinical suspicion for PCa (PSA > 4 ng/mL) underwent multiparametric MRI of the prostate (mpMRI) and, when suspicious lesion were found (according to the PIRADSv2 scoring system), targeted biopsy was performed. All patients without significant alteration patterns at mpMRI have been referred for follow-up at 1 year. RESULTS 91/108 patients showed on the mpMRI highly suspicious lesions (PIRADS 4 and 5); the remaining 17/108 patients revealed no significant alteration consistent with PCa (PIRADS 3). Among the first group of patients, 58/91 proved to be positive for PCa on the pathology report: 24 patients had a Gleason Score (GS) 6 (3 + 3); 18 patients GS 7 of which 7 (3 + 4) and 11 (4 + 3); 14 patients GS 8 (4 + 4); two patients GS 9 (5 + 4); 33 proved to be negative. Overall cancer detection rate (CDR) was 63%. However, the CDR rises significantly, up to 77%, after the 53 initial consecutive biopsies that were performed (p < 0,05) and thus identified as part of the learning curve. Patients of the second group (17/108) have been followed with serial PSA assessments, clinical reevaluation, and follow-up mpMRI. CONCLUSION Performing exclusively targeted MR/Ultrasound Fusion-Guided biopsies for the diagnosis of PCa in patients with suspicious PSA levels (> 4 ng/mL) increases the detection rate of clinically significant cancer, changing both the therapeutic options and the prognosis.
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Affiliation(s)
- Maurizio Del Monte
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | | | - Vincenzo Salvo
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Marcello Domenico Grompone
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Martina Pecoraro
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Riccardo Campa
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Francesco Vullo
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | | | - Carlo Catalano
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Valeria Panebianco
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy.
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Faiella E, Santucci D, Greco F, Frauenfelder G, Giacobbe V, Muto G, Zobel BB, Grasso RF. Analysis of histological findings obtained combining US/mp-MRI fusion-guided biopsies with systematic US biopsies: mp-MRI role in prostate cancer detection and false negative. Radiol Med 2017; 123:143-152. [PMID: 29019021 DOI: 10.1007/s11547-017-0814-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/13/2017] [Indexed: 02/02/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the diagnostic accuracy of mp-MRI correlating US/mp-MRI fusion-guided biopsy with systematic random US-guided biopsy in prostate cancer diagnosis. MATERIALS AND METHODS 137 suspected prostatic abnormalities were identified on mp-MRI (1.5T) in 96 patients and classified according to PI-RADS score v2. All target lesions underwent US/mp-MRI fusion biopsy and prostatic sampling was completed by US-guided systematic random 12-core biopsies. Histological analysis and Gleason score were established for all the samples, both target lesions defined by mp-MRI, and random biopsies. PI-RADS score was correlated with the histological results, divided in three groups (benign tissue, atypia and carcinoma) and with Gleason groups, divided in four categories considering the new Grading system of the ISUP 2014, using t test. Multivariate analysis was used to correlate PI-RADS and Gleason categories to PSA level and abnormalities axial diameter. When the random core biopsies showed carcinoma (mp-MRI false-negatives), PSA value and lesions Gleason median value were compared with those of carcinomas identified by mp-MRI (true-positives), using t test. RESULTS There was statistically significant difference between PI-RADS score in carcinoma, atypia and benign lesions groups (4.41, 3.61 and 3.24, respectively) and between PI-RADS score in Gleason < 7 group and Gleason > 7 group (4.14 and 4.79, respectively). mp-MRI performance was more accurate for lesions > 15 mm and in patients with PSA > 6 ng/ml. In systematic sampling, 130 (11.25%) mp-MRI false-negative were identified. There was no statistic difference in Gleason median value (7.0 vs 7.06) between this group and the mp-MRI true-positives, but a significant lower PSA median value was demonstrated (7.08 vs 7.53 ng/ml). CONCLUSION mp-MRI remains the imaging modality of choice to identify PCa lesions. Integrating US-guided random sampling with US/mp-MRI fusion target lesions sampling, 3.49% of false-negative were identified.
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Affiliation(s)
- Eliodoro Faiella
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy.
| | - Domiziana Santucci
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Federico Greco
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Giulia Frauenfelder
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Viola Giacobbe
- Department of Bio-Engineering, University of Rome "Gemelli", Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Giovanni Muto
- Department of Urology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Bruno Beomonte Zobel
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Rosario Francesco Grasso
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
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Scialpi M, Martorana E, Aisa MC, Rondoni V, D'Andrea A, Bianchi G. Score 3 prostate lesions: a gray zone for PI-RADS v2. Turk J Urol 2017; 43:237-240. [PMID: 28861291 DOI: 10.5152/tud.2017.01058] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 06/26/2017] [Indexed: 12/19/2022]
Abstract
Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) does not offer a precise guidance on the clinical management (biopsy or not biopsy) for PI-RADS v2 score 3 lesions. Lesion volume calculated on biparametric MRI (bpMRI) [T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI)] by introducing a cut-off of 0.5 mL, allows to distinguish the lesions assigned by the multiparametric MRI (mpMRI) to the category PI-RADS v2 score 3 in two subgroups: a) Indolent or low risk lesions with volume <0.5 mL, and b) Significant or high risk lesions with volume ≥0.5 mL. For mpMRI lesions assigned to PI-RADS v2 score 3, we suggest the following management: 1) Subgroup a (low-risk lesion): Clinical surveillance (accurate evaluation of age and clinical informations, periodic monitoring of prostate specific antigen value and repeated bpMRI 1 year later); 2) Subgroup b (high-risk lesion): Targeted biopsy. The proposed management would reduce the use of unnecessary biopsies and increase the diagostic yield of significant prostate cancer of approximately 50% and 30% respectively. These approaches encourage the radiologist to adopt MRI lesion volume to improve PI-RADS v2 and to optimize the management of PI-RADS v2 score 3 lesions.
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Affiliation(s)
- Michele Scialpi
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, Perugia University, S.Maria Della Misericordia Hospital, S. Andrea Delle Fratte, Perugia, Italy
| | | | - Maria Cristina Aisa
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, Perugia University, S.Maria Della Misericordia Hospital, S. Andrea Delle Fratte, Perugia, Italy
| | - Valeria Rondoni
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, Perugia University, S.Maria Della Misericordia Hospital, S. Andrea Delle Fratte, Perugia, Italy
| | - Alfredo D'Andrea
- Department of Experimental Medicine, Magrassi Lanzara, Second University of Naples, Italy
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