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Koopaei S, Fathi Kazerooni A, Ghafoori M, Alviri M, Pashaei F, Saligheh Rad H. Quantification of Multi-Parametric Magnetic Resonance Imaging Based on Radiomics Analysis for Differentiation of Benign and Malignant Lesions of Prostate. J Biomed Phys Eng 2023; 13:251-260. [PMID: 37312887 PMCID: PMC10258207 DOI: 10.31661/jbpe.v0i0.2008-1158] [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: 08/15/2020] [Accepted: 10/28/2020] [Indexed: 06/15/2023]
Abstract
Background The most common cancer (non-cutaneous) malignancy among men is prostate cancer. Management of prostate cancer, including staging and treatment, playing an important role in decreasing mortality rates. Among all current diagnostic tools, multiparametric MRI (mp-MRI) has shown high potential in localizing and staging prostate cancer. Quantification of mp-MRI helps to decrease the dependency of diagnosis on readers' opinions. Objective The aim of this research is to set a method based on quantification of mp-MRI images for discrimination between benign and malignant prostatic lesions with fusion-guided MR imaging/transrectal ultrasonography biopsy as a pathology validation reference. Material and Methods It is an analytical research that 27 patients underwent the mp-MRI examination, including T1- and T2- weighted and diffusion weighted imaging (DWI). Quantification was done by calculating radiomic features from mp-MRI images. Receiver-operating-characteristic curve was done for each feature to evaluate the discriminatory capacity and linear discriminant analysis (LDA) and leave-one-out cross-validation for feature filtering to estimate the sensitivity, specificity and accuracy of the benign and malignant lesion differentiation process is used. Results An accuracy, sensitivity and specificity of 92.6%, 95.2% and 83.3%, respectively, were achieved from a subset of radiomics features obtained from T2-weighted images and apparent diffusion coefficient (ADC) maps for distinguishing benign and malignant prostate lesions. Conclusion Quantification of mp-MRI (T2-weighted images and ADC-maps) based on radiomics feature has potential to distinguish benign with appropriate accuracy from malignant prostate lesions. This technique is helpful in preventing needless biopsies in patients and provides an assisted diagnosis for classifications of prostate lesions.
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Affiliation(s)
- Soheila Koopaei
- Quantitative MR Imaging and Spectroscopy Group, Research Center for Molecular and Cellular Imaging, Institute for Advanced Medical Technologies, Imam Hospital, Tehran, Iran
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science Tehran, Iran
| | - Anahita Fathi Kazerooni
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science Tehran, Iran
| | - Mahyar Ghafoori
- Department of Radiology, Hazrat Rasoul Akram University Hospital, Tehran, Iran
| | - Mohamadreza Alviri
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science Tehran, Iran
| | - Fakhereh Pashaei
- Quantitative MR Imaging and Spectroscopy Group, Research Center for Molecular and Cellular Imaging, Institute for Advanced Medical Technologies, Imam Hospital, Tehran, Iran
- Radiation Sciences Research Center (RSRC), Aja University of Medical Sciences, Tehran, Iran
| | - Hamidreza Saligheh Rad
- Quantitative MR Imaging and Spectroscopy Group, Research Center for Molecular and Cellular Imaging, Institute for Advanced Medical Technologies, Imam Hospital, Tehran, Iran
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science Tehran, Iran
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2
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Li X, Li C, Chen M. Patients With "Gray Zone" PSA Levels: Application of Prostate MRI and MRS in the Diagnosis of Prostate Cancer. J Magn Reson Imaging 2023; 57:992-1010. [PMID: 36326563 DOI: 10.1002/jmri.28505] [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: 09/06/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Improving the detection rates of prostate cancer (PCa) and avoiding unnecessary prostate biopsies in men with prostate-specific antigen (PSA) levels within the gray zone require urgent attention. In this context, rapid advances in MR technology in recent years may offer a promising possibility. A systematic review to evaluate the applications of magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) in detecting PCa and clinically significant PCa (csPCa) in men with PSA levels within the gray zone. The study type is defined as systematic review. In July 2022, out of 229 studies identified by the database search and from other sources, 23 articles related to the selected topic of interest were included in this review. No field strength or sequence restrictions. The data including the study population, study characteristics, as well as basic MRI characteristics, from the final studies included in this review, were extracted independently by two reviewers. The major results of the original study were summarized and no additional statistical analysis was performed. Among the 23 studies included in this review, 17 focused on the applications of MRS and MRI for the prebiopsy diagnosis of PCa. Nine of these 17 articles used Prostate Imaging Reporting and Data System (PI-RADS) score to interpret MRI results, thereby confirming the practicality of the PI-RADS score in predicting PCa and csPCa. The remaining six articles evaluated the applications of MRI and MRS in guiding prostate biopsy. Although there was a variation in the biopsy modalities used in these studies, both MRI- and MRS-guided prostate biopsies were observed to improve the detection rates of PCa and csPCa in patients with PSA levels within the gray zone. MRS and MRI showed good performance in the detection of PCa and csPCa before biopsy. In addition, MRS- or MRI-guided prostate-targeted biopsies were able to improve the detection rates of PCa and csPCa. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Xue Li
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunmei Li
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Zhen L, Liu X, Yegang C, Yongjiao Y, Yawei X, Jiaqi K, Xianhao W, Yuxuan S, Rui H, Wei Z, Ningjing O. Accuracy of multiparametric magnetic resonance imaging for diagnosing prostate Cancer: a systematic review and meta-analysis. BMC Cancer 2019; 19:1244. [PMID: 31870327 PMCID: PMC6929472 DOI: 10.1186/s12885-019-6434-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 12/04/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The application of multiparametric magnetic resonance imaging (mpMRI) for diagnosis of prostate cancer has been recommended by the European Association of Urology (EAU), National Comprehensive Cancer Network (NCCN), and European Society of Urogenital Radiology (ESUR) guidelines. The purpose of this study is to systematically review the literature on assessing the accuracy of mpMRI in patients with suspicion of prostate cancer. METHOD We searched Embase, Pubmed and Cochrane online databases from January 12,000 to October 272,018 to extract articles exploring the possibilities that the pre-biopsy mpMRI can enhance the diagnosis accuracy of prostate cancer. The numbers of true- and false-negative results and true- and false-positive ones were extracted to calculate the corresponding sensitivity and specificity of mpMRI. Study quality was assessed using QUADAS-2 tool. Random effects meta-analysis and a hierarchical summary receiver operating characteristic (HSROC) plot were performed for further study. RESULTS After searching, we acquired 3741 articles for reference, of which 29 studies with 8503 participants were eligible for inclusion. MpMRI maintained impressive diagnostic value, the area under the HSROC curve was 0.87 (95%CI,0.84-0.90). The sensitivity and specificity for mpMRI were 0.87 [95%CI, 0.81-0.91] and 0.68 [95%CI,0.56-0.79] respectively. The positive likelihood ratio was 2.73 [95%CI 1.90-3.90]; negative likelihood ratio was 0.19 [95% CI 0.14,-0.27]. The risk of publication bias was negligible with P = 0.96. CONCLUSION Results of the meta-analysis suggest that mpMRI is a sensitive tool to diagnose prostate cancer. However, because of the high heterogeneity existing among the included studies, further studies are needed to apply the results of this meta-analysis in clinic.
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Affiliation(s)
- Liang Zhen
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Chen Yegang
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yang Yongjiao
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Xu Yawei
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Kang Jiaqi
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Wang Xianhao
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Song Yuxuan
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Hu Rui
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Zhang Wei
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Ou Ningjing
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
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Yin W, Chen J, Wang G, Zhang D. MicroRNA‑106b functions as an oncogene and regulates tumor viability and metastasis by targeting LARP4B in prostate cancer. Mol Med Rep 2019; 20:951-958. [PMID: 31173237 PMCID: PMC6625195 DOI: 10.3892/mmr.2019.10343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/07/2019] [Indexed: 01/10/2023] Open
Abstract
Prostate cancer (PCa) is the most common malignancy among males worldwide, and is one of the leading causes of cancer‑related mortality. MicroRNAs (miRs) are a type of endogenous, noncoding RNA that serve a key role in pathological processes, and have been demonstrated to be involved in the formation and progression of PCa. Previous studies have reported that miR‑106b acts as an oncogene; however, the specific effects of miR‑106b on PCa have not been fully elucidated. The present study aimed to investigate the role and underlying molecular mechanisms of miR‑106b in the initiation and progression of PCa. In this study, miR‑106b was reported to be overexpressed and la‑related protein 4B (LARP4B) was downregulated in PCa tissues compared with paracancerous tissues. In addition, LARP4B was identified as a target gene of miR‑106b by bioinformatics prediction analysis and a dual luciferase reporter gene assay. Furthermore, MTT, wound healing and Transwell assays were performed to evaluate PCa cell viability, and migration and invasive abilities. The data revealed that inhibition of miR‑106b significantly suppressed the viability, migration and invasion of PCa cells. In addition, inhibition of miR‑106b significantly suppressed the mRNA and protein expression of cancer‑related genes, including matrix metalloproteinase‑2, cluster of differentiation 44 and Ki‑67, and increased that of the tumor suppressor, mothers against decapentaplegic homolog 2. Collectively, the findings of the present study indicated that miR‑106b may target LAR4B to inhibit cancer cell viability, migration and invasion, and may be considered as a novel therapeutic target in PCa.
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Affiliation(s)
- Weiqi Yin
- Department of Urology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Junfeng Chen
- Department of Urology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Guoyao Wang
- Department of Urology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Dongxu Zhang
- Department of Urology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
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5
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Kaushal R, Das CJ, Singh P, Dogra PN, Kumar R. Multiparametric magnetic resonance imaging-transrectal ultrasound fusion biopsies increase the rate of cancer detection in populations with a low incidence of prostate cancer. Investig Clin Urol 2019; 60:156-161. [PMID: 31098422 PMCID: PMC6495042 DOI: 10.4111/icu.2019.60.3.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/11/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To prospectively evaluate the diagnostic yield of multiparametric magnetic resonance imaging (mpMRI)-fusion, transrectal ultrasound (TRUS)-guided prostate biopsies for detection of prostate cancer in an Asian population with a low incidence of prostate cancer. Materials and Methods A total of 131 males with suspected prostate cancer were recruited to undergo fusion biopsy with the Artemis prostate fusion biopsy device (Eigen, Grass Valley, CA, USA). All patients underwent standard 12-core systematic biopsies in addition to biopsies targeted at the mpMRI-identified abnormal regions. Yield from the standard cores was compared with that from the targeted cores. Gleason scores of 4+3 or higher were considered significant. Results The mean age of the patients was 63.54±7.96 years and the mean prostate-specific antigen value was 9.75±5.35 ng/mL. A total of 36 patients had cancer, of which 3 (8.3%) were detected only on standard cores and 3 (8.3%) only on targeted cores. Of the clinically significant cancers (n=30), targeted biopsy detected a higher number (28/30, 93.3%) than standard biopsy (21/30, 70.0%). A total of 6 of 8 cancers (75.0%) that were insignificant on standard biopsy were upgraded to significant cancer on targeted cores. Conclusions Eight percent of cancers were detected only on MRI-TRUS fusion-targeted biopsies, whereas the method upgraded more than two-thirds of insignificant cancers to significant cancers. Fusion biopsies thus provide incremental information over standard TRUS biopsies in the diagnosis of significant prostate cancer in populations with a low incidence of prostate cancer.
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Affiliation(s)
- Rohit Kaushal
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan J Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prem Nath Dogra
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Cai W, Zhu D, Byanju S, Chen J, Zhang H, Wang Y, Liao M. Magnetic resonance spectroscopy imaging in diagnosis of suspicious prostate cancer: A meta-analysis. Medicine (Baltimore) 2019; 98:e14891. [PMID: 30946315 PMCID: PMC6456084 DOI: 10.1097/md.0000000000014891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This meta-analysis was conducted to assess the value of magnetic resonance spectroscopy imaging (MRSI) in the diagnosis of suspected prostate cancer (PC). METHODS We identified all the relevant papers from the EMBASE, PubMed, EBSCO, Web of Science, and Cochrane Library databases and screened the reference lists. The quality assessment of diagnostic accuracy studies-version 2 tool was used to assess the study quality. Publication bias was analyzed using Deeks' funnel plot asymmetry test. We calculated the pooled sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, diagnostic odds ratio (DOR), and 95% confidence intervals. The results were evaluated by summary receiver-operating characteristic curves (SROCs). Ultimately, a univariable meta-regression and subgroup analysis, Fagan plot, and likelihood matrix were used to analyze this review. RESULTS A total of 19 articles, which were based on patient-level analysis of PC, were included. These studies had a pooled sensitivity, specificity, DOR, and an area under the SROC of 0.86, 0.78, 22, and 0.89, respectively, by patient-level analysis. From the likelihood matrix, the summary negative likelihood ratio and positive likelihood ratio for MRSI diagnosis of PC were concentrated on the right lower quadrant, which neither confirmed nor excluded the diagnosis of cancer. CONCLUSION MRSI has a relative application value in the diagnosis of cases of suspected PC. While MRSI is still required for diagnosis along with other clinical data and comprehensive analysis.
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7
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Zadra G, Loda M. Metabolic Vulnerabilities of Prostate Cancer: Diagnostic and Therapeutic Opportunities. Cold Spring Harb Perspect Med 2018; 8:cshperspect.a030569. [PMID: 29229664 DOI: 10.1101/cshperspect.a030569] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cancer cells hijack metabolic pathways to support bioenergetics and biosynthetic requirements for their uncontrolled growth. Thus, cancer can be considered as a metabolic disease. In this review, we discuss the main metabolic features of prostate cancer with a particular focus on the link between oncogene-directed cancer metabolic regulation, metabolism rewiring, and epigenetic regulation. The potential of using metabolic profiling as a means to predict disease behavior and to identify novel therapeutic targets and new diagnostic markers will be addressed as well as the current challenges in metabolomics analyses. Finally, diagnostic and prognostic metabolic imaging approaches, including positron emission tomography, mass spectrometry, nuclear magnetic resonance, and their translational applications, will be discussed. Here, we emphasize how targeting metabolic vulnerabilities in prostate cancer may pave the way for novel personalized diagnostic and therapeutic interventions.
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Affiliation(s)
- Giorgia Zadra
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02215.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215
| | - Massimo Loda
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02215.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215.,The Broad Institute, Cambridge, Massachusetts 02142
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8
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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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Fusco R, Sansone M, Granata V, Setola SV, Petrillo A. A systematic review on multiparametric MR imaging in prostate cancer detection. Infect Agent Cancer 2017; 12:57. [PMID: 29093748 PMCID: PMC5663098 DOI: 10.1186/s13027-017-0168-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/23/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Literature data suggest that multi-parametric Magnetic Resonance Imaging (MRI), including morphologic T2-weigthed images (T2-MRI) and functional approaches such as Dynamic Contrast Enhanced-MRI (DCE-MRI), Diffusion Weighted Imaging (DWI) and Magnetic Resonance Spectroscopic Imaging (MRSI), give an added value in the prostate cancer localization and local staging. METHODS We performed a systematic review of literature about the role and the potentiality of morphological and functional MRI in prostate cancer, also in a multimodal / multiparametric approach, and we reported the diagnostic accuracy results for different imaging modalities and for different MR coil settings: endorectal coil (ERC) and phased array coil (PAC). Forest plots and receiver operating characteristic curves were performed. Risk of bias and the applicability at study level were calculated. RESULTS Thirty three papers were identified for the systematic review. Sensitivity and specificity values were, respectively, for T2-MRI of 75% and of 60%, for DCE-MRI of 80% and of 72%, for MRSI of 89% and of 69%, for combined T2-MRI and DCE-MRI of 87% and of 46%, for combined T2-MRI and MRSI of 79% and of 57%, for combined T2-MRI, DWI and DCE-MRI of 81% and of 84%, and for combined MRSI and DCE-MRI of 83% and of 83%. For MRI studies performed with ERC we obtained a pooled sensitivity and specificity of 81% and of 66% while the pooled values for MRI studies performed with PAC were of 78% and of 64%, respectively (p>0.05 at McNemar test). No studies were excluded from the analysis based on the quality assessment. CONCLUSIONS ERC use yielded no additional benefit in terms of prostate cancer detection accuracy compared to multi-channel PAC use (71% versus 68%) while the use of additional functional imaging techniques (DCE-MRI, DWI and MRSI) in a multiparametric MRI protocol improves the accuracy of prostate cancer detection allowing both the early cure and the guidance of biopsy.
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Affiliation(s)
- Roberta Fusco
- Radiology Unit, “Dipartimento di supporto ai percorsi oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale”, Via Mariano Semmola, Naples, Italy
| | - Mario Sansone
- Department of Electrical Engineering and Information Technologies, University “Federico II” of Naples, Via Claudio, Naples, Italy
| | - Vincenza Granata
- Radiology Unit, “Dipartimento di supporto ai percorsi oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale”, Via Mariano Semmola, Naples, Italy
| | - Sergio Venanzio Setola
- Radiology Unit, “Dipartimento di supporto ai percorsi oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale”, Via Mariano Semmola, Naples, Italy
| | - Antonella Petrillo
- Radiology Unit, “Dipartimento di supporto ai percorsi oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale”, Via Mariano Semmola, Naples, Italy
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Dwivedi DK, Kumar R, Dwivedi AK, Bora GS, Thulkar S, Sharma S, Gupta SD, Jagannathan NR. Prebiopsy multiparametric MRI-based risk score for predicting prostate cancer in biopsy-naive men with prostate-specific antigen between 4-10 ng/mL. J Magn Reson Imaging 2017; 47:1227-1236. [PMID: 28872226 DOI: 10.1002/jmri.25850] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/24/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Risk calculators have traditionally utilized serum prostate-specific antigen (PSA) values in addition to clinical variables to predict the likelihood of prostate cancer (PCa). PURPOSE To develop a prebiopsy multiparametric MRI (mpMRI)-based risk score (RS) and a statistical equation for predicting the risk of PCa in biopsy-naive men with serum PSA between 4-10 ng/mL that may help reduce unnecessary biopsies. STUDY TYPE Prospective cross-sectional study. SUBJECTS In all, 137 consecutive men with PSA between 4-10 ng/mL underwent prebiopsy mpMRI (diffusion-weighted [DW]-MRI and MR spectroscopic imaging [MRSI]) during 2009-2015 were recruited for this study. FIELD STRENGTH/SEQUENCE 1.5T (Avanto, Siemens Health Care, Erlangen, Germany); T1 -weighted, T2 -weighted, DW-MRI, and MRSI sequences were used. ASSESSMENT All eligible patients underwent mpMRI-directed, cognitive-fusion transrectal ultrasound (TRUS)-guided biopsies. STATISTICAL TESTS An equation model and an RS were developed using receiver operating characteristic (ROC) curve analysis and a multivariable logistic regression approach. A 10-fold crossvalidation and simulation analyses were performed to assess diagnostic performance of various combinations of mpMRI parameters. RESULTS Of 137 patients, 32 were diagnosed with PCa on biopsy. Multivariable analysis, adjusted with positive pathology, showed apparent diffusion coefficient (ADC), metabolite ratio, and PSA as significant predictors of PCa (P < 0.05). A statistical equation was derived using these predictors. A simple 6-point mpMRI-based RS was derived for calculating the risk of PCa and it showed that it is highly predictive for PCa (odds ratio = 3.74, 95% confidence interval [CI]: 2.24-6.27, area under the curve [AUC] = 0.87). Both models (equation and RS) yielded high predictive performance (AUC ≥0.85) on validation analysis. DATA CONCLUSION A statistical equation and a simple 6-point mpMRI-based RS can be used as a point-of-care tool to potentially help limit the number of negative biopsies in men with PSA between 4 and 10 ng/mL. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1227-1236.
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Affiliation(s)
- Durgesh Kumar Dwivedi
- Department of NMR & MRI Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Kumar Dwivedi
- Division of Biostatistics and Epidemiology, Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Girdhar S Bora
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
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Jiménez Londoño G, García Vicente A, Amo-Salas M, Fúnez Mayorga F, López Guerrero M, Talavera Rubio M, Gutierrez Martin P, González García B, de la Torre Pérez J, Soriano Castrejón Á. Role of 18 F-Choline PET/CT in guiding biopsy in patients with risen PSA levels and previous negative biopsy for prostate cancer. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Jiménez Londoño GA, García Vicente AM, Amo-Salas M, Fúnez Mayorga F, López Guerrero MA, Talavera Rubio MP, Gutierrez Martin P, González García B, de la Torre Pérez JA, Soriano Castrejón ÁM. Role of 18F-Choline PET/CT in guiding biopsy in patients with risen PSA levels and previous negative biopsy for prostate cancer. Rev Esp Med Nucl Imagen Mol 2017; 36:241-246. [PMID: 28330596 DOI: 10.1016/j.remn.2017.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/23/2016] [Accepted: 01/03/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To study 18F-Choline PET/CT in the diagnosis and biopsy guide of prostate cancer (pCa) in patients with persistently high prostate-specific antigen (PSA) and previous negative prostate biopsy. To compare the clinical risk factors and metabolic variables as predictors of malignancy. METHODS Patients with persistently elevated PSA in serum (total PSA >4ng/mL) and at least a previous negative or inconclusive biopsy were consecutively referred for a whole body 18F-Choline PET/CT. Patient age, PSA level, PSA doubling time (PSAdt) and PSA velocity (PSAvel) were obtained. PET images were visually (positive or negative) and semiquantitatively (SUVmax) reviewed. 18F-Choline uptake prostate patterns were defined as focal, multifocal, homogeneous or heterogeneous. Histology on biopsy using transrectal ultrasound-guided approach was the gold standard. Sensitivity (Se), specificity (Sp) and accuracy (Ac) of PET/CT for diagnosis of pCa were evaluated using per-patient and per-prostate lobe analysis. Receiver-operating-characteristic (ROC) curve analysis was used to assess the value of SUVmax to diagnose pCa. Correlation between PET/CT and biopsy results per-prostate lobe was assessed using the Chi-square test. Univariate and multivariate logistic regression analysis were applied to compare clinical risk factors and metabolic variables as predictors of malignancy. RESULTS Thirty-six out of 43 patients with histologic confirmation were included. In 11 (30.5%) patients, pCa was diagnosed (Gleason score from 4 to 9). The mean values of patient age, PSA level, PSAdt and PSAvel were: 65.5 years, 15.6ng/ml, 28.1 months and 8.5ng/mL per year, respectively. Thirty-three patients had a positive PET/CT; 18 had a focal pattern, 7 multifocal, 4 homogeneous and 4 heterogeneous. Se, Sp and Ac of PET/CT were of 100%, 12% and 38% in the patient based analysis, and 87%, 29% and 14% in the prostate lobe based analysis, respectively. The ROC curve analysis of SUVmax showed an AUC of 0.568 (p=0.52). On a lobe analysis, poor agreement was observed between PET/CT findings and biopsy results (p=0.097). In the univariate/multivariate analysis, none of clinical and metabolic variables were statistically significant as predictor of pCa. CONCLUSION Choline PET/CT is a suitable procedure for the detection of pCa in highly selected patients, however, a high rate of false positive should be expected.
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Affiliation(s)
- G A Jiménez Londoño
- Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain.
| | - A M García Vicente
- Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - M Amo-Salas
- Mathematic Department, University of Castilla La Mancha, Ciudad Real, Spain
| | - F Fúnez Mayorga
- Urology Department, Hospital Virgen de Altagracia, Manzanares, Ciudad Real, Spain
| | | | - M P Talavera Rubio
- Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - P Gutierrez Martin
- Urology Department, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - B González García
- Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - J A de la Torre Pérez
- Urology Department, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - Á M Soriano Castrejón
- Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
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Moldovan PC, Van den Broeck T, Sylvester R, Marconi L, Bellmunt J, van den Bergh RCN, Bolla M, Briers E, Cumberbatch MG, Fossati N, Gross T, Henry AM, Joniau S, van der Kwast TH, Matveev VB, van der Poel HG, De Santis M, Schoots IG, Wiegel T, Yuan CY, Cornford P, Mottet N, Lam TB, Rouvière O. What Is the Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in Excluding Prostate Cancer at Biopsy? A Systematic Review and Meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel. Eur Urol 2017; 72:250-266. [PMID: 28336078 DOI: 10.1016/j.eururo.2017.02.026] [Citation(s) in RCA: 270] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/16/2017] [Indexed: 11/16/2022]
Abstract
CONTEXT It remains unclear whether patients with a suspicion of prostate cancer (PCa) and negative multiparametric magnetic resonance imaging (mpMRI) can safely obviate prostate biopsy. OBJECTIVE To systematically review the literature assessing the negative predictive value (NPV) of mpMRI in patients with a suspicion of PCa. EVIDENCE ACQUISITION The Embase, Medline, and Cochrane databases were searched up to February 2016. Studies reporting prebiopsy mpMRI results using transrectal or transperineal biopsy as a reference standard were included. We further selected for meta-analysis studies with at least 10-core biopsies as the reference standard, mpMRI comprising at least T2-weighted and diffusion-weighted imaging, positive mpMRI defined as a Prostate Imaging Reporting Data System/Likert score of ≥3/5 or ≥4/5, and results reported at patient level for the detection of overall PCa or clinically significant PCa (csPCa) defined as Gleason ≥7 cancer. EVIDENCE SYNTHESIS A total of 48 studies (9613 patients) were eligible for inclusion. At patient level, the median prevalence was 50.4% (interquartile range [IQR], 36.4-57.7%) for overall cancer and 32.9% (IQR, 28.1-37.2%) for csPCa. The median mpMRI NPV was 82.4% (IQR, 69.0-92.4%) for overall cancer and 88.1% (IQR, 85.7-92.3) for csPCa. NPV significantly decreased when cancer prevalence increased, for overall cancer (r=-0.64, p<0.0001) and csPCa (r=-0.75, p=0.032). Eight studies fulfilled the inclusion criteria for meta-analysis. Seven reported results for overall PCa. When the overall PCa prevalence increased from 30% to 60%, the combined NPV estimates decreased from 88% (95% confidence interval [95% CI], 77-99%) to 67% (95% CI, 56-79%) for a cut-off score of 3/5. Only one study selected for meta-analysis reported results for Gleason ≥7 cancers, with a positive biopsy rate of 29.3%. The corresponding NPV for a cut-off score of ≥3/5 was 87.9%. CONCLUSIONS The NPV of mpMRI varied greatly depending on study design, cancer prevalence, and definitions of positive mpMRI and csPCa. As cancer prevalence was highly variable among series, risk stratification of patients should be the initial step before considering prebiopsy mpMRI and defining those in whom biopsy may be omitted when the mpMRI is negative. PATIENT SUMMARY This systematic review examined if multiparametric magnetic resonance imaging (MRI) scan can be used to reliably predict the absence of prostate cancer in patients suspected of having prostate cancer, thereby avoiding a prostate biopsy. The results suggest that whilst it is a promising tool, it is not accurate enough to replace prostate biopsy in such patients, mainly because its accuracy is variable and influenced by the prostate cancer risk. However, its performance can be enhanced if there were more accurate ways of determining the risk of having prostate cancer. When such tools are available, it should be possible to use an MRI scan to avoid biopsy in patients at a low risk of prostate cancer.
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Affiliation(s)
- Paul C Moldovan
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Van den Broeck
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - Richard Sylvester
- European Association of Urology Guidelines Office, Brussels, Belgium
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Joaquim Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Michel Bolla
- Department of Radiation Therapy, CHU Grenoble, Grenoble, France
| | | | | | - Nicola Fossati
- Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Tobias Gross
- Department of Urology, University of Bern, Inselspital, Bern, Switzerland
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | | | | | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MCUniversity Medical Center, Rotterdam, The Netherlands; Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Cathy Yuhong Yuan
- Division of Gastroenterology and Cochrane UGPD Group, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada
| | - Philip Cornford
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Olivier Rouvière
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France; Université Lyon 1, faculté de médecine Lyon Est, Lyon, France.
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Ross T, Ahmed K, Raison N, Challacombe B, Dasgupta P. Clarifying the PSA grey zone: The management of patients with a borderline PSA. Int J Clin Pract 2016; 70:950-959. [PMID: 27672001 DOI: 10.1111/ijcp.12883] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/31/2016] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Prostate specific antigen is a marker for prostate cancer and a key diagnostic tool, yet when to refer patients with a borderline PSA is currently unclear. This review describes how to assess a patient with borderline PSA and provides an algorithm for management. METHODS Current literature on reference values, factors affecting PSA, indications for referral, non-invasive investigations and the role of MRI were reviewed. Medline and EMBASE were searched using MeSH terms. RESULTS The literature suggests that a PSA of over 1.5 ng/mL should be used as a cut-off to consider further testing for all age groups. There is strong evidence to show that adjuncts are useful when interpreting PSA results, most notably percentage free PSA and proPSA. Considerable weighting should also be given to the ERSPC risk calculator when deciding when to refer. Multi-parametric MRI is valuable in closely examining suspicious lesions to reduce the number of negative biopsies. MRI fusion biopsy (TRUS, transrectal ultrasonography or transperineal) should be considered over standard TRUS biopsy to detect more clinically significant disease. CONCLUSIONS Management of borderline PSA is not straightforward. A cut-off of 1.5 ng/mL should be used in conjunction with digital rectal exam, risk calculation and PSA adjuncts. Imaging and biopsy should utilise mpMRI to achieve improved diagnosis of clinically significant prostate cancer, with fewer unnecessary investigations.
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Affiliation(s)
- Talisa Ross
- Guy's Hospital, King's College London, London, UK
| | - Kamran Ahmed
- Guy's Hospital, King's College London, London, UK
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Haider MA, Yao X, Loblaw A, Finelli A. Multiparametric Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer: A Systematic Review. Clin Oncol (R Coll Radiol) 2016; 28:550-67. [PMID: 27256655 DOI: 10.1016/j.clon.2016.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 03/15/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
Abstract
A systematic review was conducted to investigate the use of multiparametric magnetic resonance imaging (MPMRI) followed by targeted biopsy in the diagnosis of clinically significant prostate cancer (CSPC) and to compare it with transrectal ultrasound-guided (TRUS-guided) systematic biopsy in patients with an elevated risk of prostate cancer who are either biopsy-naive or who have a previous negative TRUS-guided biopsy. MEDLINE, PubMed and EMBASE (1997 to April 2014), the Cochrane Library and six relevant conferences were searched to find eligible studies. Search terms indicative of 'prostate cancer' and 'magnetic resonance imaging' with their alternatives were used. Twelve systematic reviews, 52 full texts and 28 abstracts met the preplanned study selection criteria; data from 15 articles were extracted. In patients with an elevated risk of prostate cancer who were biopsy-naive, MPMRI followed by targeted biopsy could detect 2-13% of CSPC patients whom TRUS-guided systematic biopsy missed; TRUS-guided systematic biopsy could detect 0-7% of CSPC patients whom MPMRI followed by targeted biopsy missed. In patients with an elevated risk of prostate cancer who had a previous negative TRUS-guided biopsy, MPMRI followed by targeted biopsy detected more CSPC patients than repeated TRUS-guided systematic biopsy in all four studies, with a total of 516 patients, but only one study reached a statistically significant difference. In patients with an elevated risk of prostate cancer who are biopsy-naive, there is insufficient evidence for MPMRI followed by targeted biopsy to be considered the standard of care. In patients who had a prior negative TRUS-guided systematic biopsy and show a growing risk of having CSPC, MPMRI followed by targeted biopsy may be helpful to detect more CSPC cases as opposed to a repeat TRUS-guided systematic biopsy.
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Affiliation(s)
- M A Haider
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - X Yao
- Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada.
| | - A Loblaw
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - A Finelli
- Princess Margaret Hospital, Toronto, Ontario, Canada
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16
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Multiparametric MR can identify high grade prostatic intraepithelial neoplasia (HGPIN) lesions and predict future detection of prostate cancer in men with a negative initial prostate biopsy. Magn Reson Imaging 2016; 34:1081-6. [PMID: 27211254 DOI: 10.1016/j.mri.2016.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 05/11/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE This study aims to determine the pre-biopsy diffusion-weighted imaging (DWI) and magnetic resonance spectroscopic imaging (MRSI) characteristics of patients with high-grade prostatic intraepithelial neoplasia (HGPIN) and perform follow-up studies in these patients to assess the clinical implications. MATERIALS AND METHODS One hundred sixteen men with prostate specific antigen between 4 and 10ng/ml underwent pre-biopsy MR examinations. Nine of them had HGPIN lesions without concomitant prostate cancer (PCa) on biopsy. Apparent diffusion coefficient (ADC) and metabolite ratio [Citrate/(Choline+Creatine)] were calculated and these 9 patients were followed to determine the clinical outcomes. RESULTS Mean ADC for HGPIN foci was 1.01±0.16×10(-3)mm(2)/s while for the normal peripheral zone it was 1.69±0.25×10(-3)mm(2)/s (p<0.005). Mean metabolite ratio for voxels in the HGPIN region of initial biopsy was 0.24±0.16 while for the normal peripheral zone the value was 2.66±1.57 (p<0.005). Four of 5 patients who were available for follow-up were detected to have prostate cancer on repeat biopsy. No significant change in metabolite ratio and PSA was observed while ADC showed further reduction on follow-up. CONCLUSION HGPIN foci have ADC and metabolite ratio values similar to adenocarcinoma prostate, indicating that such patients have a high likelihood of developing cancer. DWI may help identify such men who may be candidates for close follow-up.
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Dwivedi DK, Kumar R, Bora GS, Thulkar S, Sharma S, Gupta SD, Jagannathan NR. Stratification of the aggressiveness of prostate cancer using pre-biopsy multiparametric MRI (mpMRI). NMR IN BIOMEDICINE 2016; 29:232-238. [PMID: 26730884 DOI: 10.1002/nbm.3452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 06/05/2023]
Abstract
Risk stratification, based on the Gleason score (GS) of a prostate biopsy, is an important decision-making tool in prostate cancer management. As low-grade disease may not need active intervention, the ability to identify aggressive cancers on imaging could limit the need for prostate biopsies. We assessed the ability of multiparametric MRI (mpMRI) in pre-biopsy risk stratification of men with prostate cancer. One hundred and twenty men suspected to have prostate cancer underwent mpMRI (diffusion MRI and MR spectroscopic imaging) prior to biopsy. Twenty-six had cancer and were stratified into three groups based on GS: low grade (GS ≤ 6), intermediate grade (GS = 7) and high grade (GS ≥ 8). A total of 910 regions of interest (ROIs) from the peripheral zone (PZ, range 25-45) were analyzed from these 26 patients. The metabolite ratio [citrate/(choline + creatine)] and apparent diffusion coefficient (ADC) of voxels were calculated for the PZ regions corresponding to the biopsy cores and compared with histology. The median metabolite ratios for low-grade, intermediate-grade and high-grade cancer were 0.29 (range: 0.16, 0.61), 0.17 (range: 0.13, 0.32) and 0.13 (range: 0.05, 0.23), respectively (p = 0.004). The corresponding mean ADCs (×10(-3) mm(2) /s) for low-grade, intermediate-grade and high-grade cancer were 0.99 ± 0.08, 0.86 ± 0.11 and 0.69 ± 0.12, respectively (p < 0.0001). The combined ADC and metabolite ratio model showed strong discriminatory ability to differentiate subjects with GS ≤ 6 from subjects with GS ≥ 7 with an area under the curve of 94%. These data indicate that pre-biopsy mpMRI may stratify PCa aggressiveness noninvasively. As the recent literature data suggest that men with GS ≤ 6 cancer may not need radical therapy, our data may help limit the need for biopsy and allow informed decision making for clinical intervention. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Durgesh Kumar Dwivedi
- Department of NMR & MRI Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Girdhar S Bora
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Multiparametric-magnetic resonance imaging (mp-MRI) has shown promising results in diagnosis, localization, risk stratification and staging of clinically significant prostate cancer. It has also opened up opportunities for focal treatment of prostate cancer. Combinations of T2-weighted imaging, diffusion imaging, perfusion (dynamic contrast-enhanced imaging) and spectroscopic imaging have been used in mp-MRI assessment of prostate cancer, but T2 morphologic assessment and functional assessment by diffusion imaging remains the mainstay for prostate cancer diagnosis on mp-MRI. Because assessment on mp-MRI can be subjective, use of the newly developed standardized reporting Prostate Imaging and Reporting Archiving Data System scoring system and education of specialist radiologists are essential for accurate interpretation. This review focuses on the present status of mp-MRI in prostate cancer and its evolving role in the management of prostate cancer.
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Affiliation(s)
- Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Ontario, Canada
| | - Masoom A Haider
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Ontario, Canada
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Yoo S, Kim JK, Jeong IG. Multiparametric magnetic resonance imaging for prostate cancer: A review and update for urologists. Korean J Urol 2015; 56:487-97. [PMID: 26175867 PMCID: PMC4500805 DOI: 10.4111/kju.2015.56.7.487] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/22/2015] [Indexed: 12/17/2022] Open
Abstract
Recently, imaging of prostate cancer has greatly advanced since the introduction of multiparametric magnetic resonance imaging (mpMRI). mpMRI consists of T2-weighted sequences combined with several functional sequences including diffusion-weighted imaging, dynamic contrast-enhanced imaging, and/or magnetic resonance spectroscopy imaging. Interest has been growing in mpMRI because no single MRI sequence adequately detects and characterizes prostate cancer. During the last decade, the role of mpMRI has been expanded in prostate cancer detection, staging, and targeting or guiding prostate biopsy. Recently, mpMRI has been used to assess prostate cancer aggressiveness and to identify anteriorly located tumors before and during active surveillance. Moreover, recent studies have reported that mpMRI is a reliable imaging modality for detecting local recurrence after radical prostatectomy or external beam radiation therapy. In this regard, some urologic clinical practice guidelines recommended the use of mpMRI in the diagnosis and management of prostate cancer. Because mpMRI is the evolving reference standard imaging modality for prostate cancer, urologists should acquire cutting-edge knowledge about mpMRI. In this article, we review the literature on the use of mpMRI in urologic practice and provide a brief description of techniques. More specifically, we state the role of mpMRI in prostate biopsy, active surveillance, high-risk prostate cancer, and detection of recurrence after radical prostatectomy.
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Affiliation(s)
- Sangjun Yoo
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Kon Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Goris Gbenou MC. Editorial Comment to Magnetic resonance spectroscopy imaging-directed transrectal ultrasound biopsy increases prostate cancer detection in men with prostate-specific antigen between 4-10 ng/mL and normal digital rectal examination. Int J Urol 2013; 21:262-3. [PMID: 24015755 DOI: 10.1111/iju.12274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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