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Beckmann KR, O'Callaghan ME, Vincent AD, Moretti KL, Brook NR. Clinical outcomes for men with positive surgical margins after radical prostatectomy-results from the South Australian Prostate Cancer Clinical Outcomes Collaborative community-based registry. Asian J Urol 2023; 10:502-511. [PMID: 38024435 PMCID: PMC10659979 DOI: 10.1016/j.ajur.2022.02.014] [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: 05/28/2021] [Revised: 12/16/2021] [Accepted: 02/08/2022] [Indexed: 10/14/2022] Open
Abstract
Objective Positive surgical margins (PSMs) after radical prostatectomy (RP) indicate failure of surgery to completely clear cancer. PSMs confer an increased risk of biochemical recurrence (BCR), but how more robust outcomes are affected is unclear. This study investigated factors associated with PSMs following RP and determined their impact on clinical outcomes (BCR, second treatment [radiotherapy and/or androgen deprivation therapy], and prostate cancer-specific mortality [PCSM]). Methods The study cohort included men diagnosed with prostate cancer (pT2-3b/N0/M0) between January 1998 and June 2016 who underwent RP from the South Australian Prostate Cancer Clinical Outcomes Collaborative database. Factors associated with risk of PSMs were identified using Poisson regression. The impact of PSMs on clinical outcomes (BCR, second treatment, and PCSM) was assessed using competing risk regression. Results Of the 2827 eligible participants, 28% had PSMs-10% apical, 6% bladder neck, 17% posterolateral, and 5% at multiple locations. Median follow-up was 9.6 years with 81 deaths from prostate cancer recorded. Likelihood of PSM increased with higher pathological grade and pathological tumor stage, and greater tumour volume, but decreased with increasing surgeon volume (odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.88-0.98, per 100 previous prostatectomies). PSMs were associated with increased risk of BCR (adjusted sub-distribution hazard ratio [sHR] 2.5; 95% CI 2.1-3.1) and second treatment (sHR 2.9; 95% CI 2.4-3.5). Risk of BCR was increased similarly for each PSM location, but was higher for multiple margin sites. We found no association between PSMs and PCSM. Conclusion Our findings support previous research suggesting that PSMs are not independently associated with PCSM despite strong association with BCR. Reducing PSM rates remains an important objective, given the higher likelihood of secondary treatment with associated comorbidities.
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Affiliation(s)
- Kerri R. Beckmann
- Cancer Epidemiology and Population Health Research, University of South Australia, Adelaide, Australia
- Translational Oncology and Urology Research, Division of Pharmaceutical and Cancer Studies, Kings College London, London, UK
| | - Michael E. O'Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, Australia
| | - Andrew D. Vincent
- The Freemason's Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Kim L. Moretti
- Cancer Epidemiology and Population Health Research, University of South Australia, Adelaide, Australia
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, Australia
- Discipline of Surgery, University of Adelaide, Adelaide, Australia
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Dang J, Yao Y, Li Y, Tan X, Ye Z, Zhao Y, Qing S, Kou Y, Jiang X, Lu H, Chen S, Zhao M, Cheng Z. An exploratory study of unexplained concentration of 18F-PSMA-1007 in the bladder for prostate cancer PET/CT imaging. Front Med (Lausanne) 2023; 10:1238333. [PMID: 37727766 PMCID: PMC10505956 DOI: 10.3389/fmed.2023.1238333] [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: 06/11/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023] Open
Abstract
18F-PSMA-1007 PET/CT imaging is increasingly used for the diagnosis, staging, and efficacy assessment of patients with prostate cancer. Compared with other PSMA tracers, 18F-PSMA-1007 is mainly cleared by the liver and bile and has lower urinary clearance, thus allowing a better assessment of the lesions around the bladder. However, there were some patients who showed an obvious concentration of the 18F-PSMA-1007 in the bladder, which may affect the observation of peripheral lesions, but the mechanism of this change is unknown. The aim of this study was to explore the cause of bladder 18F-PSMA-1007 concentration by assessing the clinical and imaging characteristics of 18F-PSMA-1007 PET/CT scans. A total of 284 patients were included in this retrospective study, and their clinical characteristics such as age, height, weight, Gleason score, metastases, different treatment methods, the level of liver and kidney function, PSA level, and imaging characteristics such as 18F-PSMA-1007 injected activity, the interval between injection to scan, physiological distribution (parotid gland, kidney, liver, spleen, intestine, obturator internus), pathological distribution (prostate lesions, metastases) were collected, and were compared after subgrouping using bladder urine SUVmax. This study showed that the distribution of bladder 18F-PSMA-1007 was not correlated with the above clinical and imaging characteristics, so further studies are needed to find the explanations, and thus to improve the disease assessment of this type of prostate cancer patients.
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Affiliation(s)
- Jun Dang
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yutang Yao
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yingchun Li
- Department of Nuclear Medicine and Radiotherapy, Air Force Hospital of Western Theater Command, Chengdu, China
| | - Xiaofei Tan
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Zhenyan Ye
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Zhao
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Shiwei Qing
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Ying Kou
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xiao Jiang
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Lu
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Shirong Chen
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Meng Zhao
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Zhuzhong Cheng
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
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Ueda T, Ohno Y, Shinohara M, Yamamoto K, Ikedo M, Yui M, Yoshikawa T, Takenaka D, Ishida S, Furuta M, Matsuyama T, Nagata H, Ikeda H, Ozawa Y, Toyama H. Reverse encoding distortion correction for diffusion-weighted MRI: Efficacy for improving image quality and ADC evaluation for differentiating malignant from benign areas in suspected prostatic cancer patients. Eur J Radiol 2023; 162:110764. [PMID: 36905716 DOI: 10.1016/j.ejrad.2023.110764] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE The purpose of this study was to determine the influenceof reverse encoding distortion correction (RDC) on ADC measurement and its efficacy for improving image quality and diagnostic performance for differentiating malignant from benign prostatic areas on prostatic DWI. METHODS Forty suspected prostatic cancer patients underwent DWI with or without RDC (i.e. RDC DWI or DWI) using a 3 T MR system as well as pathological examinations. The pathological examination results indicated 86 areas were malignant while 86 out of 394 areas were computationally selected as benign. SNR for benign areas and muscle and ADCs for malignant and benign areas were determined by ROI measurements on each DWI. Moreover, overall image quality was assessed with a 5-point visual scoring system on each DWI. Paired t-test or Wilcoxon's signed rank test was performed to compare SNR and overall image quality for DWIs. ROC analysis was then used to compare the diagnostic performance, and sensitivity (SE), specificity (SP) and accuracy (AC) of ADC were compared between two DWI by means of McNemar's test. RESULTS SNR and overall image quality of RDC DWI showed significant improvements when compared with those of DWI (p < 0.05). Areas under the curve (AUC), SP and AC of DWI RDC DWI (AUC: 0.85, SP: 72.1%, AC: 79.1%) were significantly better than those of DWI (AUC: 0.79, p = 0.008; SP: 64%, p = 0.02; AC: 74.4%, p = 0.008). CONCLUSION RDC technique has the potential to improve image quality and ability to differentiate malignant from benign prostatic areas on DWIs of suspected prostatic cancer patients.
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Affiliation(s)
- Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yoshiharu Ohno
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | | | - Kaori Yamamoto
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Masato Ikedo
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Masao Yui
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Takeshi Yoshikawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Daisuke Takenaka
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Sayuri Ishida
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Minami Furuta
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takahiro Matsuyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hirotaka Ikeda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yoshiyuki Ozawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Value of Targeted Biopsies and Combined PSMA PET/CT and mp-MRI Imaging in Locally Recurrent Prostate Cancer after Primary Radiotherapy. Cancers (Basel) 2022; 14:cancers14030781. [PMID: 35159048 PMCID: PMC8834189 DOI: 10.3390/cancers14030781] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary After primary radiotherapy for prostate cancer, patients may develop an isolated local recurrence. The diagnostic workup of these recurrences guides decision making for potential focal salvage treatments. The aim of this study was to determine the positive predictive value (PPV) of combined multiparametric (mp) MRI and prostate specific membrane antigen (PSMA) PET/CT imaging in this setting, with histological conformation using MR-guided targeted biopsies. In 41 patients counseled for focal salvage high dose rate (HDR) brachytherapy, a PPV of 97.6% was found for combined mp-MRI and PSMA PET/CT. Therefore, biopsies can safely be omitted in these patients. Abstract Radiorecurrent prostate cancer is conventionally confirmed using systematic and/or targeted biopsies. The availability of multiparametric (mp) MRI and prostate specific membrane antigen (PSMA) PET/CT has increased diagnostic accuracy. The objective was to determine the positive predictive value (PPV) of combined mp-MRI and PSMA PET/CT and whether pathology verification with MR-targeted biopsies remains necessary for patients with radiorecurrent prostate cancer. Patients with locally recurrent prostate cancer who were referred for 19 Gy single-dose MRI-guided focal salvage high dose rate (HDR) brachytherapy between 2015 and 2018 were included in the current analysis. Patients were selected if they underwent pre-biopsy mp-MRI and PSMA PET/CT. Based on these images, lesions suspect for isolated tumor recurrence were transperineally biopsied using transrectal ultrasound fused with MRI. A total of 41 patients were identified from the database who underwent cognitive targeted (n = 7) or MRI/PSMA-transrectal ultrasound (TRUS) fused targeted (n = 34) biopsies. A total of 40 (97.6%) patients had positive biopsies for recurrent cancer. Five patients initially had negative biopsies (all MRI/PSMA-TRUS fusion targeted), four of whom recurrence was confirmed after a re-biopsy. One (2.4%) patient refused re-biopsy, leading to a positive predictive value (PPV) for combined imaging of 97.6%. Biopsies can therefore safely be withheld when the results of the combined mp-MRI and PSMA PET/CT are conclusive, avoiding an unnecessary invasive and burdensome procedure.
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Ueda T, Ohno Y, Yamamoto K, Murayama K, Ikedo M, Yui M, Hanamatsu S, Tanaka Y, Obama Y, Ikeda H, Toyama H. Deep Learning Reconstruction of Diffusion-weighted MRI Improves Image Quality for Prostatic Imaging. Radiology 2022; 303:373-381. [PMID: 35103536 DOI: 10.1148/radiol.204097] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Deep learning reconstruction (DLR) may improve image quality. However, its impact on diffusion-weighted imaging (DWI) of the prostate has yet to be assessed. Purpose To determine whether DLR can improve image quality of diffusion-weighted MRI at b values ranging from 1000 sec/mm2 to 5000 sec/mm2 in patients with prostate cancer. Materials and Methods In this retrospective study, images of the prostate obtained at DWI with a b value of 0 sec/mm2, DWI with a b value of 1000 sec/mm2 (DWI1000), DWI with a b value of 3000 sec/mm2 (DWI3000), and DWI with a b value of 5000 sec/mm2 (DWI5000) from consecutive patients with biopsy-proven cancer from January to June 2020 were reconstructed with and without DLR. Image quality was assessed using signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) from region-of-interest analysis and qualitatively assessed using a five-point visual scoring system (1 [very poor] to 5 [excellent]) for each high-b-value DWI sequence with and without DLR. The SNR, CNR, and visual score for DWI with and without DLR were compared with the paired t test and the Wilcoxon signed rank test with Bonferroni correction, respectively. Apparent diffusion coefficients (ADCs) from DWI with and without DLR were also compared with the paired t test with Bonferroni correction. Results A total of 60 patients (mean age, 67 years; age range, 49-79 years) were analyzed. DWI with DLR showed significantly higher SNRs and CNRs than DWI without DLR (P < .001); for example, with DWI1000 the mean SNR was 38.7 ± 0.6 versus 17.8 ± 0.6, respectively (P < .001), and the mean CNR was 18.4 ± 5.6 versus 7.4 ± 5.6, respectively (P < .001). DWI with DLR also demonstrated higher qualitative image quality than DWI without DLR (mean score: 4.8 ± 0.4 vs 4.0 ± 0.7, respectively, with DWI1000 [P = .001], 3.8 ± 0.7 vs 3.0 ± 0.8 with DWI3000 [P = .002], and 3.1 ± 0.8 vs 2.0 ± 0.9 with DWI5000 [P < .001]). ADCs derived with and without DLR did not differ substantially (P > .99). Conclusion Deep learning reconstruction improves the image quality of diffusion-weighted MRI scans of prostate cancer with no impact on apparent diffusion coefficient quantitation with a 3.0-T MRI system. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Turkbey in this issue.
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Affiliation(s)
- Takahiro Ueda
- From the Department of Radiology (T.U., Y. Ohno, S.H., Y.T., Y. Obama, H.I., H.T.) and Joint Research Laboratory of Advanced Medical Imaging (Y. Ohno, K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; and Canon Medical Systems Corporation, Otawara, Japan (K.Y., M.I., M.Y.)
| | - Yoshiharu Ohno
- From the Department of Radiology (T.U., Y. Ohno, S.H., Y.T., Y. Obama, H.I., H.T.) and Joint Research Laboratory of Advanced Medical Imaging (Y. Ohno, K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; and Canon Medical Systems Corporation, Otawara, Japan (K.Y., M.I., M.Y.)
| | - Kaori Yamamoto
- From the Department of Radiology (T.U., Y. Ohno, S.H., Y.T., Y. Obama, H.I., H.T.) and Joint Research Laboratory of Advanced Medical Imaging (Y. Ohno, K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; and Canon Medical Systems Corporation, Otawara, Japan (K.Y., M.I., M.Y.)
| | - Kazuhiro Murayama
- From the Department of Radiology (T.U., Y. Ohno, S.H., Y.T., Y. Obama, H.I., H.T.) and Joint Research Laboratory of Advanced Medical Imaging (Y. Ohno, K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; and Canon Medical Systems Corporation, Otawara, Japan (K.Y., M.I., M.Y.)
| | - Masato Ikedo
- From the Department of Radiology (T.U., Y. Ohno, S.H., Y.T., Y. Obama, H.I., H.T.) and Joint Research Laboratory of Advanced Medical Imaging (Y. Ohno, K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; and Canon Medical Systems Corporation, Otawara, Japan (K.Y., M.I., M.Y.)
| | - Masao Yui
- From the Department of Radiology (T.U., Y. Ohno, S.H., Y.T., Y. Obama, H.I., H.T.) and Joint Research Laboratory of Advanced Medical Imaging (Y. Ohno, K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; and Canon Medical Systems Corporation, Otawara, Japan (K.Y., M.I., M.Y.)
| | - Satomu Hanamatsu
- From the Department of Radiology (T.U., Y. Ohno, S.H., Y.T., Y. Obama, H.I., H.T.) and Joint Research Laboratory of Advanced Medical Imaging (Y. Ohno, K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; and Canon Medical Systems Corporation, Otawara, Japan (K.Y., M.I., M.Y.)
| | - Yumi Tanaka
- From the Department of Radiology (T.U., Y. Ohno, S.H., Y.T., Y. Obama, H.I., H.T.) and Joint Research Laboratory of Advanced Medical Imaging (Y. Ohno, K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; and Canon Medical Systems Corporation, Otawara, Japan (K.Y., M.I., M.Y.)
| | - Yuki Obama
- From the Department of Radiology (T.U., Y. Ohno, S.H., Y.T., Y. Obama, H.I., H.T.) and Joint Research Laboratory of Advanced Medical Imaging (Y. Ohno, K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; and Canon Medical Systems Corporation, Otawara, Japan (K.Y., M.I., M.Y.)
| | - Hirotaka Ikeda
- From the Department of Radiology (T.U., Y. Ohno, S.H., Y.T., Y. Obama, H.I., H.T.) and Joint Research Laboratory of Advanced Medical Imaging (Y. Ohno, K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; and Canon Medical Systems Corporation, Otawara, Japan (K.Y., M.I., M.Y.)
| | - Hiroshi Toyama
- From the Department of Radiology (T.U., Y. Ohno, S.H., Y.T., Y. Obama, H.I., H.T.) and Joint Research Laboratory of Advanced Medical Imaging (Y. Ohno, K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; and Canon Medical Systems Corporation, Otawara, Japan (K.Y., M.I., M.Y.)
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Ekmekcioglu O, Yavuzsan AH, Arican P, Kirecci SL. Is there a nonnegligible effect of maximum standardized uptake value in the staging and management of prostate cancer with 68Ga-prostate-specific membrane antigen positron emission tomography/computerized tomography imaging? A single-center experience. J Cancer Res Ther 2021; 17:1351-1357. [PMID: 34916365 DOI: 10.4103/jcrt.jcrt_1223_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose Prostate-specific membrane antigen (PSMA) positron emission tomography/computerized tomography (PET/CT) has been shown to have significant success in detecting local and distant metastases that cannot not be detected by conventional imaging. Initial staging in intermediate- and high-risk patients with prostate cancer is important for management. In addition, PSMA uptake has been shown to have a relation with grade of disease, and thus could be considered a separate noninvasive prognostic factor. In this study, we aimed to investigate the effect of PSMA PET/CT in the staging and management of prostate cancer patients as well as the relation to maximum standardized uptake value (SUVmax). Methods The patients referred to our department for staging prostate cancer were evaluated retrospectively (n = 65). Patients were grouped as positive for lymph node or distant metastatic disease. Primary tumor SUVmax data were compared with the prognostic factors of the disease. In addition, decisions about treatment protocol before and after PSMA PET/CT imaging were noted. Results All the patients except one were accepted as positive for primary tumor. Of the patients, 46.2% were positive for lymph node and 24.6% for distant metastases. After evaluation by PSMA PET/CT, the clinical choice of treatment changed for 43.1% of our patients. Primary tumor SUVmax and tumor-to-background SUVmax ratios were found to have a significant relation with D'Amico risk classification. We found a positive correlation between SUVmax and prostate-specific antigen, Gleason scores, and age. Conclusion PSMA PET/CT images have a nonnegligible effect on staging, clinical decisions, and change in treatment protocol. SUVmax data have a positive correlation with risk classification and could be identified as a potential independent and non-invasive prognostic factor.
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Affiliation(s)
- Ozgul Ekmekcioglu
- Department of Nuclear Medicine, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Abdullah Hizir Yavuzsan
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Pelin Arican
- Department of Nuclear Medicine, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Sinan Levent Kirecci
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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Zanoni L, Bianchi L, Nanni C, Pultrone C, Giunchi F, Bossert I, Matti A, Schiavina R, Fiorentino M, Romagnoli D, Fonti C, Lodi F, D'Errico A, Brunocilla E, Porreca A, Fanti S. [ 18F]-Fluciclovine PET/CT for preoperative nodal staging in high-risk primary prostate cancer: final results of a prospective trial. Eur J Nucl Med Mol Imaging 2021; 49:390-409. [PMID: 34213609 DOI: 10.1007/s00259-021-05429-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/24/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The conventional imaging flowchart for prostate cancer (PCa) staging may fail in correctly detecting lymph node metastases (LNM). Pelvic lymph node dissection (PLND) represents the only reliable method, although invasive. A new amino acid PET compound, [18F]-fluciclovine, was recently authorized in suspected PCa recurrence but not yet included in the standard staging work-up of primary PCa. A prospective monocentric study was designed to evaluate [18F]-fluciclovine PET/CT diagnostic performance for preoperative LN staging in primary high-risk PCa. METHODS Consecutive patients (pts) with biopsy-proven PCa, standard staging (including [11C]choline PET/CT), eligible for PLND, were enrolled to undergo an investigational [18F]-fluciclovine PET/CT. Nodal uptake higher than surrounding background was reported by at least two readers (blinded to [11C]choline) using a visual 5-point scale (1-2 probably negative; 4-5 probably positive; 3 equivocal); SUVmax, target-to-background (aorta-A; bone marrow-BM) ratios (TBRs), were also calculated. PET results were validated with PLND. [18F]-fluciclovine PET/CT performance using visual score and semi-quantitative indexes was analyzed both per patient and per LN anatomical region, compared to conventional [11C]choline and clinical predictive factors (to note that diagnostic performance of [18F]-fluciclovine was explored for LNM but not examined for intrapelvic or extrapelvic M1 lesions). RESULTS Overall, 94 pts underwent [18F]-fluciclovine PET/CT; 72/94 (77%) high-risk pts were included in the final analyses (22 pts excluded: 8 limited PLND; 3 intermediate-risk; 2 treated with radiotherapy; 4 found to be M1; 5 neoadjuvant hormonal therapy). Median LNM risk by Briganti nomogram was 19%. LNM confirmed on histology was 25% (18/72 pts). Overall, 1671 LN were retrieved; 45/1671 (3%) LNM detected. Per pt, median no. of removed LN was 22 (mean 23 ± 10; range 8-51), of LNM was 2 (mean 3 ± 2; range 1-10). Median LNM size was 5 mm (mean 5 ± 2.5; range 2-10). On patient-based analyses (n = 72), diagnostic performance for LNM resulted significant with [18F]-fluciclovine (AUC 0.66, p 0.04; 50% sensitivity, 81% specificity, 47% PPV, 83% NPV, 74% accuracy), but not with [11C]choline (AUC 0.60, p 0.2; 50%, 70%, 36%, 81%, and 65% respectively). Briganti nomogram (OR = 1.03, p = 0.04) and [18F]-fluciclovine visual score (≥ 4) (OR = 4.27, p = 0.02) resulted independent predictors of LNM at multivariable analyses. On region-based semi-quantitative analyses (n = 576), PET/CT performed better using TBR parameters (TBR-A similar to TBR-BM; TBR-A fluciclovine AUC 0.61, p 0.35, vs choline AUC 0.57 p 0.54; TBR-BM fluciclovine AUC 0.61, p 0.36, vs choline AUC 0.58, p 0.52) rather than using absolute LN SUVmax (fluciclovine AUC 0.51, p 0.91, vs choline AUC 0.51, p 0.94). However, in all cases, diagnostic performance was not statistically significant for LNM detection, although slightly in favor of the experimental tracer [18F]-fluciclovine for each parameter. On the contrary, visual interpretation significantly outperformed PET semi-quantitative parameters (choline and fluciclovine: AUC 0.65 and 0.64 respectively; p 0.03) and represents an independent predictive factor of LNM with both tracers, in particular [18F]-fluciclovine (OR = 8.70, p 0.002, vs OR = 3.98, p = 0.03). CONCLUSION In high-risk primary PCa, [18F]-fluciclovine demonstrates some advantages compared with [11C]choline but sensitivity for metastatic LN detection is still inadequate compared to PLND. Visual (combined morphological and functional), compared to semi-quantitative assessment, is promising but relies mainly on readers' experience rather than on unquestionable LN avidity. TRIAL REGISTRATION EudraCT number: 2014-003,165-15.
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Affiliation(s)
- Lucia Zanoni
- Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
| | - Lorenzo Bianchi
- Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Cristian Pultrone
- Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesca Giunchi
- Pathology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Irene Bossert
- Nuclear Medicine, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Antonella Matti
- Nuclear Medicine, IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar Di Valpolicella, (VR), Italy
| | - Riccardo Schiavina
- Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Michelangelo Fiorentino
- Department of Specialistic Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | | | - Cristina Fonti
- Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Filippo Lodi
- Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Antonietta D'Errico
- Pathology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Stefano Fanti
- Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- DIMES, University of Bologna, Bologna, Italy
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8
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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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9
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Chessa F, Schiavina R, Ercolino A, Gaudiano C, Giusti D, Bianchi L, Pultrone C, Marcelli E, Distefano C, Lodigiani L, Brunocilla E. Diagnostic accuracy of the Novel 29 MHz micro-ultrasound "ExactVuTM" for the detection of clinically significant prostate cancer: A prospective single institutional study. A step forward in the diagnosis of prostate cancer. Arch Ital Urol Androl 2021; 93:132-138. [PMID: 34286543 DOI: 10.4081/aiua.2021.2.132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE ExactVuTM is a real-time micro-ultrasound system which provides, according to the Prostate Risk Identification Using Micro-Ultrasound protocol (PRI-MUS), a 300% higher resolution compared to conventional transrectal ultrasound. To evaluate the performance of ExactVuTM in the detection of Clinically significant Prostate Cancer (CsPCa). MATERIALS AND METHODS Patients with Prostate Cancer diagnosed at fusion biopsy were imaged with ExactVuTM. CsPCa was defined as any Gleason Score ≥ 3+4. ExactVuTM examination was considered as positive when PRI-MUS score was ≥ 3. PRI-MUS scoring system was considered as correct when the fusion biopsy was positive for CsPCa. A transrectal fusion biopsy- proven CsPCa was considered as a gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operator characteristic (ROC) curve (AUC) were calculated. RESULTS 57 patients out of 68 (84%) had a csPCa. PRI-MUS score was correctly assessed in 68% of cases. Regarding the detection of CsPCa, ExactVuTM 's sensitivity, specificity, PPV, and NPV was 68%, 73%, 93%, and 31%, respectively and the AUC was 0.7 (95% CI 0.5-0-8). For detecting CsPCa in the transition/ anterior zone the sensitivity, specificity, PPV, and NPV was 45%, 66%, 83% and 25% respectively ant the AUC was 0.5 (95% CI 0.2-0.9). Accounting only the CsPCa located in the peripheral zone, sensitivity, specificity, PPV, and NPV raised up to 74%, 75%, 94%, 33%, respectively with AUC 0.75 (95% CI 0.5-0-9). CONCLUSIONS ExactVuTM provides high resolution of the prostatic peripheral zone and could represent a step forward in the detection of CsPCa as a triage tool. Further studies are needed to confirm these promising results.
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Affiliation(s)
- Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna; Department of Urology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna.
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna; Department of Urology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna.
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna.
| | - Caterina Gaudiano
- Division of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna.
| | - Davide Giusti
- Division of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna.
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna; Department of Urology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna.
| | - Cristian Pultrone
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna; Department of Urology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna.
| | - Emanuela Marcelli
- Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna.
| | - Concetta Distefano
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna.
| | | | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna; Department of Urology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna.
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10
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Zhao Y, Ge Y, He Q. Preoperative Staging Diagnosis of Colorectal Cancer Based on Multi-Row Spiral CT. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Colorectal cancer is a common malignant tumor of digestive tract, and its incidence has increased significantly in recent years. The 5-year survival rate of patients with early local colorectal cancer is more than 90%, with local invasion of about 68%, and distant metastasis of less
than 10%. Therefore, early diagnosis and early treatment is an effective means for the prevention and treatment of colorectal cancer. At present, X-ray air-barium double contrast radiography and fiberoptic endoscope are most commonly used in the examination of colorectal tumors in the world.
These two methods have the advantages of simple operation, intuition and low cost. However, it is limited to judge the depth of tumor invasion, whether to break through the serosa, lymphatic metastasis, and distant metastasis. In this work, it can be confirmed that the measurement of preoperative
tumor vascular volume reconstruction density is feasible in the preoperative evaluation of colorectal cancer, it will provide clinicians with more valuable information about preoperative tumor staging. Besides, multi-slice spiral CT has the advantages of less trauma, high speed, and clear
image. It can not only judge the location of the tumor, the depth, and extent of tumor invasion, and show distant organ metastasis, but also has good application value in tumor staging. In this paper, the clinical data and MSCT imaging data of patients with colorectal cancer were analyzed
retrospectively, and the value of MSCT in the diagnosis of colorectal cancer was discussed.
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Affiliation(s)
- Yuwen Zhao
- Department of Anorectal Medicine, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou Zhejiang 311400, China
| | - Yujie Ge
- Department of Radiology, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou Zhejiang 311400, China
| | - Qunfeng He
- Department of Anorectal Medicine, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou Zhejiang 311400, China
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11
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Zanoni L, Mei R, Bianchi L, Giunchi F, Maltoni L, Pultrone CV, Nanni C, Bossert I, Matti A, Schiavina R, Fiorentino M, Fonti C, Lodi F, D’Errico A, Brunocilla E, Fanti S. The Role of [ 18F]Fluciclovine PET/CT in the Characterization of High-Risk Primary Prostate Cancer: Comparison with [ 11C]Choline PET/CT and Histopathological Analysis. Cancers (Basel) 2021; 13:cancers13071575. [PMID: 33805543 PMCID: PMC8037300 DOI: 10.3390/cancers13071575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary The role of [18F]Fluciclovine Positron Emission Tomography/Computed Tomography (PET/CT) in the characterization of intra-prostatic lesions was evaluated in high-risk primary PCa patients, scheduled for radical surgery, comparing investigational [18F]Fluciclovine and conventional [11C]Choline PET/CT results with the reference standard of pathologic surgical specimen. PET visual and semi-quantitative analyses were performed: for instance, patient-based, blinded to histopathology; subsequently lesion-based, unblinded, according to a pathology reference mapping. Among 19 pts, 45 malignant and 31 benign lesions were found. The highest SUVmax matched with the lobe of the index lesion in 89% of pts and a direct correlation between [18F]Fluciclovine uptake values and pISUP was demonstrated. Overall, the lesion-based performance of PET semiquantitative parameters (SUVmax, Target to background Ratio-TBRs) with either [18F]Fluciclovine or [11C]Choline, in detecting either malignant/ISUP2-5/ISUP4-5 PCa lesions, was moderate and similar (AUCs ≥ 0.70), but still inadequate (AUCs ≤ 0.81) as standalone staging procedure. TBRs (especially with threshold higher than bone marrow) may be complementary to implement malignancy targeting. Abstract The primary aim of the study was to evaluate the role of [18F]Fluciclovine PET/CT in the characterization of intra-prostatic lesions in high-risk primary PCa patients eligible for radical prostatectomy, in comparison with conventional [11C]Choline PET/CT and validated by prostatectomy pathologic examination. Secondary aims were to determine the performance of PET semi-quantitative parameters (SUVmax; target-to-background ratios [TBRs], using abdominal aorta, bone marrow and liver as backgrounds) for malignant lesion detection (and best cut-off values) and to search predictive factors of malignancy. A six sextants prostate template was created and used by PET readers and pathologists for data comparison and validation. PET visual and semi-quantitative analyses were performed: for instance, patient-based, blinded to histopathology; subsequently lesion-based, un-blinded, according to the pathology reference template. Among 19 patients included (mean age 63 years, 89% high and 11% very-high-risk, mean PSA 9.15 ng/mL), 45 malignant and 31 benign lesions were found and 19 healthy areas were selected (n = 95). For both tracers, the location of the “blinded” prostate SUVmax matched with the lobe of the lesion with the highest pGS in 17/19 cases (89%). There was direct correlation between [18F]Fluciclovine uptake values and pISUP. Overall, lesion-based (n = 95), the performance of PET semiquantitative parameters, with either [18F]Fluciclovine or [11C]Choline, in detecting either malignant/ISUP2-5/ISUP4-5 PCa lesions, was moderate and similar (AUCs ≥ 0.70) but still inadequate (AUCs ≤ 0.81) as a standalone staging procedure. A [18F]Fluciclovine TBR-L3 ≥ 1.5 would depict a clinical significant lesion with a sensitivity and specificity of 85% and 68% respectively; whereas a SUVmax cut-off value of 4 would be able to identify a ISUP 4-5 lesion in all cases (sensitivity 100%), although with low specificity (52%). TBRs (especially with threshold significantly higher than aorta and slightly higher than bone marrow), may be complementary to implement malignancy targeting.
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Affiliation(s)
- Lucia Zanoni
- Nuclear Medicine Unit, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.N.); (F.L.); (S.F.)
- Correspondence: ; Tel.: +39-051-214-3959
| | - Riccardo Mei
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (R.M.); (M.F.)
| | - Lorenzo Bianchi
- Division of Urology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (C.V.P.); (R.S.); (E.B.)
- Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy;
| | - Francesca Giunchi
- Pathology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.G.); (A.D.)
| | - Lorenzo Maltoni
- Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy;
| | - Cristian Vincenzo Pultrone
- Division of Urology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (C.V.P.); (R.S.); (E.B.)
| | - Cristina Nanni
- Nuclear Medicine Unit, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.N.); (F.L.); (S.F.)
| | - Irene Bossert
- Nuclear Medicine, Istituti Clinici Scientifici Maugeri, 27100 Pavia, Italy;
| | - Antonella Matti
- Nuclear Medicine, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Ospedale Sacro Cuore-Don Calabria, 37024 Negrar di Valpolicella (VR), Italy;
| | - Riccardo Schiavina
- Division of Urology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (C.V.P.); (R.S.); (E.B.)
- Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy;
| | - Michelangelo Fiorentino
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (R.M.); (M.F.)
| | - Cristina Fonti
- Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy;
| | - Filippo Lodi
- Nuclear Medicine Unit, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.N.); (F.L.); (S.F.)
| | - Antonietta D’Errico
- Pathology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.G.); (A.D.)
| | - Eugenio Brunocilla
- Division of Urology, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (C.V.P.); (R.S.); (E.B.)
- Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy;
| | - Stefano Fanti
- Nuclear Medicine Unit, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.N.); (F.L.); (S.F.)
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (R.M.); (M.F.)
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12
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Borghesi M, Bianchi L, Barbaresi U, Vagnoni V, Corcioni B, Gaudiano C, Fiorentino M, Giunchi F, Chessa F, Garofalo M, Bertaccini A, Angelini S, Ercolino A, Casablanca C, Droghetti M, Golfieri R, Schiavina R. Diagnostic performance of MRI/TRUS fusion-guided biopsies vs. systematic prostate biopsies in biopsy-naïve, previous negative biopsy patients and men undergoing active surveillance. Minerva Urol Nephrol 2021; 73:357-366. [PMID: 33769008 DOI: 10.23736/s2724-6051.20.03758-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND We aimed to assess the detection rate of overall PCa and csPCa, and the clinical impact of MRI/TRUS fusion targeted biopsy (FUSION-TB) compared to TRUS guided systematic biopsy (SB) in patients with different biopsy settings. METHODS Three hundred and five patients were submitted to FUSION-TB, divided into three groups: biopsy naïve patients, previous negative biopsies and patients under active surveillance (AS). All patients had a single suspicious index lesion at mpMRI. Within these groups, we enrolled men underwent both to FUSION-TB and SB in the same session. Overall detection rate of PCa and csPCa for the two biopsy methods were compared separately between the three groups of patients. RESULTS No differences were observed between the three groups concerning clinical and radiological characteristics. We found no differences in terms of overall PCa detection (66% vs. 63.8%, P=0.617) and csPCa detection (56.4% vs. 51.1%; P=0.225) concerning biopsy naïve patients. In patients previously submitted to a negative biopsy, FUSION-TB showed higher detection rate of csPCa compared to SB alone (41,3% vs. 27% respectively, P=0.038). In patients under AS, no differences were observed between FUSION-TB and SB in terms of overall PCa (50% vs. 73.1%) and csPCa (30.8% vs. 26.9%, respectively; P=0.705) detection. CONCLUSIONS Our results suggest that in men with previously negative biopsy, FUSION-TB showed significantly higher diagnostic performance for clinically significant PCa as compared to SB. Combination of FUSION-TB and SB should be recommended in AS population to offer higher chance of csPCa diagnosis.
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Affiliation(s)
- Marco Borghesi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy - .,University of Bologna, Bologna, Italy
| | - Umberto Barbaresi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valerio Vagnoni
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Beniamino Corcioni
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michelangelo Fiorentino
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Pathology, C.A. Pizzardi-Maggiore Hospital, Bologna, Italy
| | - Francesca Giunchi
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Marco Garofalo
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Stefano Angelini
- Department of Hematology, G. e C. Mazzoni Hospital, Ascoli Piceno, Italy
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
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13
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Awenat S, Piccardo A, Carvoeiras P, Signore G, Giovanella L, Prior JO, Treglia G. Diagnostic Role of 18F-PSMA-1007 PET/CT in Prostate Cancer Staging: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11030552. [PMID: 33808825 PMCID: PMC8003688 DOI: 10.3390/diagnostics11030552] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The use of prostate-specific membrane antigen (PSMA)-targeted agents for staging prostate cancer (PCa) patients using positron emission tomography/computed tomography (PET/CT) is increasing worldwide. We performed a systematic review on the role of 18F-PSMA-1007 PET/CT in PCa staging to provide evidence-based data in this setting. Methods: A comprehensive computer literature search of PubMed/MEDLINE and Cochrane Library databases for studies using 18F-PSMA-1007 PET/CT in PCa staging was performed until 31 December 2020. Eligible articles were selected and relevant information was extracted from the original articles by two authors independently. Results: Eight articles (369 patients) evaluating the role of 18F-PSMA-1007 PET/CT in PCa staging were selected. These studies were quite heterogeneous, but, overall, they demonstrated a good diagnostic accuracy of 18F-PSMA-1007 PET/CT in detecting PCa lesions at staging. Overall, higher primary PCa aggressiveness was associated with higher 18F-PSMA-1007 uptake. When compared with other radiological and scintigraphic imaging methods, 18F-PSMA-1007 PET/CT had superior sensitivity in detecting metastatic disease and the highest inter-reader agreement. 18F-PSMA-1007 PET/CT showed similar results in terms of diagnostic accuracy for PCa staging compared with PET/CT with other PSMA-targeted tracers. Dual imaging with multi-parametric magnetic resonance imaging and 18F-PSMA-1007 PET/CT may improve staging of primary PCa. Notably, 18F-PSMA-1007-PET/CT may detect metastatic disease in a significant number of patients with negative standard imaging. Conclusions: 18F-PSMA-1007 PET/CT demonstrated a good accuracy in PCa staging, with similar results compared with other PSMA-targeted radiopharmaceuticals. This method could substitute bone scintigraphy and conventional abdominal imaging for PCa staging. Prospective multicentric studies are needed to confirm these findings.
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Affiliation(s)
- Salam Awenat
- Institute for Radiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany;
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. Ospedali Galliera, 16128 Genoa, Italy;
| | | | - Giovanni Signore
- Department of Medicine, Università degli studi della Campania “L. Vanvitelli”, 81100 Caserta, Italy;
| | - Luca Giovanella
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Department of Nuclear Medicine, University Hospital Zürich and University of Zürich, 8091 Zürich, Switzerland
| | - John O. Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, 1011 Lausanne, Switzerland;
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, 1011 Lausanne, Switzerland;
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
- Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, 6900 Lugano, Switzerland
- Correspondence: ; Tel.: +0041-918118919
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14
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D'Agostino D, Romagnoli D, Giampaoli M, Bianchi FM, Corsi P, Del Rosso A, Schiavina R, Brunocilla E, Artibani W, Porreca A. "In-Bore" MRI-Guided Prostate Biopsy for Prostate Cancer Diagnosis: Results from 140 Consecutive Patients. Curr Urol 2020; 14:22-31. [PMID: 32398993 DOI: 10.1159/000499264] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/04/2019] [Indexed: 12/26/2022] Open
Abstract
Objectives Transrectal ultrasound-guided biopsy (TRUS-GB) is the current reference standard procedure for diagnosis of prostate cancer (PCa) but this procedure has limitations related to the low detection rate (DR) described in the literature. The aim of the study was to evaluate the DR efficiency, and complication rate in a pure "in-bore" magnetic resonance imaging-guided biopsy (MRI-GB) series according to the Prostate Imaging Reporting and Data System, version 2 (PI-RADS v2). Materials and Methods From July 2015 to April 2018, a series of 142 consecutive patients undergoing MRI-GB were prospectively enrolled. According to the European Society of Urogenital Radiology guidelines, the presence of clinically significant PCa (csPCa) on multiparametric magnetic resonance imaging was defined as equivocal, likely, or highly likely according to a PI-RADS v2, score of 3, 4, or 5, respectively. Results Of 142 patients, 76 (53.5%) were biopsy naive and 66 (46.5%) had ≤ 1 previous negative set of random TRUS-GB findings. The MRI-GB findings were positive in 75 of 142 patients with a DR of 52.8%. Of the 76 patients with ≤ 1 previous set of TRUS-GB, 43 had PCa found by MRI-GB, with a DR of 57.3%. The DR in the 66 biopsy-naive patients was 48% (32/66). Of the 75 patients with positive biopsy findings, 54 (80.5%) were found to have csPCa on histological examination. Of these 54 patients, 28 had an International Society of Urological Pathology grade 2; 5 had grade 3, 19 had grade 4, and 2 had grade 5. Considering the anatomic distribution of the index lesions using the PI-RADS v2 scheme, the probability of PCa was greater for lesions located in the peripheral zone (55 of 75, 73.3%) than for those in the central zone (20 of 75, 26.7%). Conclusions Our study conducted on 142 patients confirmed the greater DR of csPCa by MRI-GB, with a very low number of cores needed and a negligible incidence of complications, especially in patients with a previous negative biopsy. MRI-GB is optimal for the diagnosis of anterior and central lesions.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Marco Giampaoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | | | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | | | | | | | - Walter Artibani
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
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15
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The role of prostate-specific membrane antigen PET/computed tomography in primary staging of prostate cancer. Curr Opin Urol 2019; 29:569-577. [DOI: 10.1097/mou.0000000000000677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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16
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Kodama H, Hatakeyama S, Narita S, Takahashi M, Sakurai T, Kawamura S, Hoshi S, Ishida M, Kawaguchi T, Ishidoya S, Shimoda J, Narita T, Sato H, Mitsuzuka K, Tochigi T, Tsuchiya N, Arai Y, Habuchi T, Ohyama C. Clinical Characterization of Low Prostate-specific Antigen on Prognosis in Patients With Metastatic Castration-naive Prostate Cancer. Clin Genitourin Cancer 2019; 17:e1091-e1098. [PMID: 31575477 DOI: 10.1016/j.clgc.2019.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION This study aimed to investigate the effect of low prostate-specific antigen (PSA) on prognosis, as the association of initial PSA level with prognosis in patients with metastatic castration-naive prostate cancer (mCNPC) remains unclear. PATIENTS AND METHODS We evaluated 575 patients with mCNPC from 10 hospitals. Patients were stratified into 2 groups according to their initial PSA: PSA < 100 and PSA ≥ 100 groups. We compared castration-resistant prostate cancer (CRPC)-free survival, overall survival (OS), and OS from the CRPC diagnosis between the groups. Multivariate Cox regression analysis was performed to evaluate the effect of initial PSA level on prognosis. RESULTS Of the 575 patients, 196 (34%) patients belonged to the PSA < 100 group. No significant difference was found in patients' backgrounds except for PSA, the extent of disease, and high tumor burden between the groups. CRPC-free survival was significantly shorter in the PSA ≥ 100 group than in the PSA < 100 group. However, the OS after CRPC diagnosis was significantly shorter in the PSA < 100 group than that of the PSA ≥ 100 group. Multivariate analyses showed that PSA < 100 ng/mL was an independent factor for OS after CRPC, whereas no significant association was observed in the CRPC-free survival and OS. CONCLUSIONS A significant effect of initial PSA < 100 ng/mL on OS after CRPC was observed. PSA < 100 ng/mL might be a poor prognostic factor in patients with mCNPC after CRPC.
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Affiliation(s)
- Hirotake Kodama
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan.
| | - Shintaro Narita
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Masahiro Takahashi
- Department of Urology, Tohoku University School of Medicine, Aoba-ku, Sendai, Miyagi, Japan
| | - Toshihiko Sakurai
- Department of Urology, Yamagata University School of Medicine, Yamagata, Yamagata, Japan
| | - Sadafumi Kawamura
- Department of Urology, Miyagi Cancer Center, Shiote, Aijima, Natori, Miyagi, Japan
| | - Senji Hoshi
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Masanori Ishida
- Department of Urology, Iwate Prefectural Isawa Hospital, Mizusawa-ku, Oshu, Iwate, Japan
| | - Toshiaki Kawaguchi
- Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Shigeto Ishidoya
- Department of Urology, Sendai City Hospital, Asuto, Taihaku-ku, Sendai, Miyagi, Japan
| | - Jiro Shimoda
- Department of Urology, Iwate Prefectural Isawa Hospital, Mizusawa-ku, Oshu, Iwate, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Hiromi Sato
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University School of Medicine, Aoba-ku, Sendai, Miyagi, Japan
| | - Tatsuo Tochigi
- Department of Urology, Miyagi Cancer Center, Shiote, Aijima, Natori, Miyagi, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Yamagata University School of Medicine, Yamagata, Yamagata, Japan
| | - Yoichi Arai
- Department of Urology, Miyagi Cancer Center, Shiote, Aijima, Natori, Miyagi, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
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