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Zawaideh JP, Caglic I, Sushentsev N, Priest AN, Warren AY, Carmisciano L, Barrett T. MRI assessment of seminal vesicle involvement by prostate cancer using T2 signal intensity and volume. Abdom Radiol (NY) 2024; 49:2534-2539. [PMID: 38734785 DOI: 10.1007/s00261-024-04349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Seminal vesicle involvement (SVI) in patients with newly diagnosed prostate cancer is associated with high rates of treatment failure and tumor recurrence; correct identification of SVI allows for effective management decisions and surgical planning. METHODS This single-center retrospective study analyzed MR images of the seminal vesicles from patients undergoing radical prostatectomy with confirmed T3b disease, comparing them to a control group without SVI matched for age and Gleason grade with a final stage of T2 or T3a. Seminal vesicles were segmented by an experienced uroradiologist, "raw" and bladder-normalized T2 signal intensity, as well as SV volume, were obtained. RESULTS Among the 82 patients with SVI, 34 (41.6%) had unilateral invasion, and 48 (58.4%) had bilateral disease. There was no statistically significant difference in the degree of distension between normal and involved seminal vesicles (P = 0.08). Similarly, no statistically significant difference was identified in the raw SV T2 signal intensity (P = 0.09) between the groups. In the 159 patients analyzed, SVI was prospectively suspected in 10 of 82 patients (specificity, 100%; sensitivity, 12.2%). In all these cases, lesions macroscopically invaded the seminal vesicle, and the raw T2 signal intensity was significantly lower than that in the SVI and control groups (P = 0.02 and 0.01). CONCLUSION While signal intensity measurements in T2-weighted images may provide insight into T3b disease, our findings suggest that this data alone is insufficient to reliably predict SVI, indicating the need for further investigation and complementary diagnostic approaches.
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Affiliation(s)
- Jeries P Zawaideh
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Anne Y Warren
- Department of Pathology, Addenbrooke's Hospital, Cambridge, UK
| | - Luca Carmisciano
- Department of Health Sciences (DISSAL), Biostatistics Section, University of Genoa, Genoa, Italy
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Lin Y, Johnson LA, Fennessy FM, Turkbey B. Prostate Cancer Local Staging with Magnetic Resonance Imaging. Radiol Clin North Am 2024; 62:93-108. [PMID: 37973247 PMCID: PMC10656475 DOI: 10.1016/j.rcl.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Accurate determination of the local stage of prostate cancer is crucial for treatment planning and prognosis. The primary objective of local staging is to distinguish between organ-confined and locally advanced disease, with the latter carrying a worse clinical prognosis. The presence of locally advanced disease features of prostate cancer, such as extra-prostatic extension, seminal vesicle invasion, and positive surgical margin, can impact the choice of treatment. Over the past decade, multiparametric MRI (mpMRI) has become the preferred imaging modality for the local staging of prostate cancer and has been shown to provide accurate information on the location and extent of disease. It has demonstrated superior performance compared to staging based on traditional clinical nomograms. Despite being a relatively new technique, mpMRI has garnered considerable attention and ongoing investigations. Therefore, in this review, we will discuss the current use of mpMRI on prostate cancer local staging.
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Affiliation(s)
- Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892, USA
| | - Latrice A Johnson
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892, USA
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892, USA.
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3
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Luo P, Hu W, Jiang L, Chang S, Wu D, Li G, Dai Y. Evaluation of articular cartilage in knee osteoarthritis using hybrid multidimensional MRI. Clin Radiol 2022; 77:e518-e525. [DOI: 10.1016/j.crad.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
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4
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Carpagnano FA, Eusebi L, Tupputi U, Testini V, Giannubilo W, Bartelli F, Guglielmi G. Multiparametric MRI: Local Staging of Prostate Cancer. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00374-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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5
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Christophe C, Montagne S, Bourrelier S, Roupret M, Barret E, Rozet F, Comperat E, Coté JF, Lucidarme O, Cussenot O, Granger B, Renard-Penna R. Prostate cancer local staging using biparametric MRI: assessment and comparison with multiparametric MRI. Eur J Radiol 2020; 132:109350. [PMID: 33080549 DOI: 10.1016/j.ejrad.2020.109350] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/03/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The value of adding dynamic contrast-enhanced (DCE) imaging to T2-weighted (T2W) magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) to improve the detection and staging of prostate cancer (PCa) is unclear. The aim of this retrospective study was to compare the diagnostic performance of non-contrast biparametric MRI (bpMRI) with multiparametric MRI (mpMRI), for local staging of PCa. METHODS Ninety-two patients who underwent prostate MRI on a 3-Tesla MRI system before radical prostatectomy for PCa were included retrospectively. Four readers independently assigned a Likert score (ranging from 1 to 5) for predicting extra-prostatic extension (EPE) on T2W + DWI (bpMRI) and then on T2W + DWI + DCE imaging (mpMRI). MRI-based staging results were compared with radical prostatectomy histology. A prediction of EPE generalized linear mixed model was used to assess the added-value of DCE and discriminative power of staging accuracy by area under the receiver-operating curve (AUC ROC). RESULTS AUC was not significantly improved by DCE (mpMRI, AUC = 0.73 [95%CI: 0.655‒0.827] vs. bpMRI, AUC = 0.76 [95%CI: 0.681‒0.846]). After applying a selection procedure, only MRI criteria were retained in a multivariate model. The following criteria were significantly associated with local extension: localization in the peripheral zone (p < 0.001), maximal diameter of the lesion (<0.0001), curvilinear capsular contact on T2W (p < 0.0001), capsular irregularity on T2W (p < 0.0001), bulging on T2W (p < 0.001) and seminal vesicle hypo-signal (p < 0.001). CONCLUSION Use of bpMRI did not result in a decrease in local staging accuracy.
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Affiliation(s)
- Charlotte Christophe
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Sarah Montagne
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France; Academic Department of Radiology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Stéphanie Bourrelier
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Morgan Roupret
- Academic Department of Urology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France; Sorbonne Universités, GRC n° 5, Oncotype-Uro, Paris, France
| | - Eric Barret
- Montsouris Institute, Urology Department, Paris, F-75014, France
| | - François Rozet
- Montsouris Institute, Urology Department, Paris, F-75014, France
| | - Eva Comperat
- Sorbonne Universités, GRC n° 5, Oncotype-Uro, Paris, France; Academic Department of Pathology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Jean François Coté
- Academic Department of Pathology, Hôpital Pitié-Salpetrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Olivier Lucidarme
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Olivier Cussenot
- Sorbonne Universités, GRC n° 5, Oncotype-Uro, Paris, France; Academic Department of Urology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Benjamin Granger
- Department of Public Health, Pitié-Salpétrière Academic Hospital, AP-HP, Sorbonne Universités, AP-HP, CIC-P 1421, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR 1136, CIC-1421, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | - Raphaële Renard-Penna
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France; Academic Department of Radiology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France; Sorbonne Universités, GRC n° 5, Oncotype-Uro, Paris, France.
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Catania R, Dasyam N, Furlan A, Borhani AA. Cross-sectional imaging of seminal vesicles and vasa deferentia. Abdom Radiol (NY) 2020; 45:2049-2062. [PMID: 31897685 DOI: 10.1007/s00261-019-02368-7] [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: 10/25/2022]
Abstract
A wide spectrum of pathologies, ranging from inconsequential degenerative and senile changes to clinically significant neoplasms, can affect seminal vesicles (SVs). With rapid rise in use of magnetic resonance imaging for evaluation of prostate in recent years an increasing number of cases of incidental SV pathologies are encountered by radiologists. Despite the high contrast resolution and high spatial resolution offered by multiparametric pelvic MRI, accurate diagnosis of SV processes can at times be challenging. In this article, we review the anatomy and embryology of the SVs and vasa deferentia and then explore the spectrum of diseases affecting them.
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Affiliation(s)
- Roberta Catania
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Intensive Medicine, Institute of Radiology, IRCCS Policlinico San Matteo Foundation, University of Parvia, Parvia, Italy
| | - Navya Dasyam
- University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Alessandro Furlan
- University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Amir A Borhani
- University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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7
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Magnetta MJ, Catania R, Girometti R, Westphalen AC, Borhani AA, Furlan A. Prostate MRI: staging and decision-making. Abdom Radiol (NY) 2020; 45:2143-2153. [PMID: 32047994 DOI: 10.1007/s00261-020-02431-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Multi-parametric prostate MRI (mpMRI) plays a critical role in the diagnosis, staging, and evaluation of treatment response in patients with prostate cancer. Radiologists, through an accurate and standardized interpretation of mpMRI, can clinically stage prostate cancer and help to risk stratify patients who may benefit from more invasive treatment or exclude patients who may be harmed by overtreatment. The purpose of this article is to describe key findings to accurately stage prostate cancer with mpMRI and to describe the contexts in which mpMRI is best applied.
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Affiliation(s)
- Michael J Magnetta
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Abdominal Radiology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Roberta Catania
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
- Institute of Radiology, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital, S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, UD, Italy
| | - Antonio C Westphalen
- Departments of Radiology and Biomedical Imaging, and Urology, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, USA
| | - Amir A Borhani
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alessandro Furlan
- Division of Abdominal Radiology, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.
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8
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Popiţa C, Popiţa AR, Andrei A, Rusu A, Petruţ B, Kacso G, Bungărdean C, Bolog N, Coman I. Local staging of prostate cancer with multiparametric-MRI: accuracy and inter-reader agreement. Med Pharm Rep 2020; 93:150-161. [PMID: 32478321 PMCID: PMC7243891 DOI: 10.15386/mpr-1390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/28/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background The accuracy of prostate cancer local staging at the time of diagnosis directly influences patient prognosis and treatment. Aim To evaluate the diagnostic performance and interobserver variability of mp-MRI in local staging of prostate cancer, using the histopathologic findings at prostatectomy as the reference standard. Methods Fifty patients (mean age 64.4±7.2) with biopsy confirmed prostate cancer were included in this prospective study. All patients were examined with mp-MRI before radical prostatectomy and images were read by three independent radiologists. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy rate were calculated and compared for all three readers. Interobserver agreement was evaluated using Kappa Cohen coefficient of agreement. Results The overall Se, Sp, PPV, NPV and accuracy rates for detecting extraprostatic tumor extension (EPE) ranged between 76.5-94.1%, 45.5-84.9%, 43.8-76.2%, 83.3-96.6% and 58-88%. For evaluation of seminal vesicle invasion (SVI), the overall Se, Sp, PPV, NPV and accuracy rates ranged between 57.1-85.7%, 86.1-97.7%, 40.0-85.7%, 92.5-97.7% and 82-96%, respectively. The overall Kappa Cohen coefficient of agreement varied between 0.349-0.638 for EPE and between 0.507-0.668 for SVI. Conclusions Our results showed that 1.5T mp-MRI is a reliable method for local staging of prostate cancer, with good diagnostic performance in detecting EPE and SVI. The overall interobserver agreement rates between readers with the same level of experience in prostate MRI ranged from fair to good in the evaluation of EPE and from moderate to good for the assessment of SVI.
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Affiliation(s)
- Cristian Popiţa
- Radiology Department, Ion Chiricuţă Oncology Institute, Cluj-Napoca, Romania.,Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca-Raluca Popiţa
- Radiology Department, Ion Chiricuţă Oncology Institute, Cluj-Napoca, Romania.,Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adina Andrei
- Radiology Department, Emergency Children's Hospital, Cluj-Napoca, Romania
| | - Adriana Rusu
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bogdan Petruţ
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Ion Chiricuţă Oncology Institute, Cluj-Napoca, Romania
| | - Gabriel Kacso
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | | | - Ioan Coman
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania
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Turpin A, Girard E, Baillet C, Pasquier D, Olivier J, Villers A, Puech P, Penel N. Imaging for Metastasis in Prostate Cancer: A Review of the Literature. Front Oncol 2020; 10:55. [PMID: 32083008 PMCID: PMC7005012 DOI: 10.3389/fonc.2020.00055] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Initial staging and assessment of treatment activity in metastatic prostate cancer (PCa) patients is controversial. Indications for the various available imaging modalities are not well-established due to rapid advancements in imaging and treatment. Methods: We conducted a critical literature review of the main imaging abnormalities that suggest a diagnosis of metastasis in localized and locally advanced PCa or in cases of biological relapse. We also assessed the role of the various imaging modalities available in routine clinical practice for the detection of metastases and response to treatment in metastatic PCa patients. Results: In published clinical trials, the most commonly used imaging modalities for the detection and evaluation of therapeutic response are bone scan, abdominopelvic computed tomography (CT), and pelvic and bone magnetic resonance imaging (MRI). For the detection and follow-up of metastases during treatment, modern imaging techniques i.e., choline-positron emission tomography (PET), fluciclovine-PET, or Prostate-specific membrane antigen (PSMA)-PET provide better sensitivity and specificity. This is particularly the case of fluciclovine-PET and PSMA-PET in cases of biochemical recurrence with low values of prostate specific antigen. Conclusions: In routine clinical practice, conventional imaging still have a role, and communication between imagers and clinicians should be encouraged. Present and future clinical trials should use modern imaging methods to clarify their usage.
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Affiliation(s)
- Anthony Turpin
- Department of Medical Oncology, CHU Lille, Lille, France.,Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Edwina Girard
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - Clio Baillet
- Nuclear Medicine Department, CHU Lille, Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.,CRISTAL UMR CNRS 9189, Lille University, Villeneuve-d'Ascq, France
| | | | | | | | - Nicolas Penel
- Department of Medical Oncology, CHU Lille, Lille, France.,Medical Oncology Department, Centre Oscar Lambret, Lille, France
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De Luca S, Fiori C, Bollito E, Garrou D, Aimar R, Cattaneo G, De Cillis S, Manfredi M, Tota D, Federica M, Passera R, Porpiglia F. Risk of Gleason Score 3+4=7 prostate cancer upgrading at radical prostatectomy is significantly reduced by targeted versus standard biopsy. MINERVA UROL NEFROL 2019; 72:360-368. [PMID: 31619029 DOI: 10.23736/s0393-2249.19.03367-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study is to evaluate if multiparametric magnetic resonance (mpMRI)-transrectal ultrasound (TRUS) fusion targeted biopsy (TBx) versus untargeted standard biopsy (SBx) may decrease the rate of pathological upgrading of Gleason Score (GS) 3+4 prostate cancer (PCa) at radical prostatectomy (RP). We also evaluated the impact of percent pattern 4 and cribriform glands at biopsy in the risk of GS 3+4=7 upgrading. METHODS A total of 301 patients with GS 3+4 PCa on biopsy (159 SBx and 142 TBx) who underwent laparoscopic robot-assisted RP were sequentially enrolled. Histological data from RP sections were used as reference standard. The concordance of biopsy with pathological GS, as well as the GS 3+4 upgrading at RP were evaluated in different univariate and multivariate binary logistic regression models, testing age, PSA, fPSA%, tumor volume, PI-RADS, clinical stage, percentage of Gleason pattern 4 (GP) and/or presence of cribriform sub-type at biopsy. RESULTS Of the 301 biopsies, the median of GP 4 was 16% of the tissue. Minimal GP 4 (≤16%) cancers had a significant lower median volume (1.7 mL) than those with GP4 >16% (2.9 mL), (P<0.001). Pathological GS 3+4 was confirmed for 58.8% and 82.2% for SBx and TBx patients, respectively. The rate of upgraded and downgraded GS on SBx versus TBx was 38.8% vis. 16.7% and 1.8% and 2.1%, respectively. The rate of upgrading was significantly associated with the presence of GP4 >16% versus ≤16% (OR 4.4, 95% CI 1.4-12.0; P=0.021) and with the presence of cribriform sub-type at biopsy specimens (OR 6.2, 95% CI 2.2-18.7; P<0.001). CONCLUSIONS We demonstrated that TBx technique significantly reduced the risk of GS 3+4 upgrading at RP, compared to SBx one. The rate of upgrading was significantly associated with GP4>16%, mostly when cribriform sub-type was present at biopsy specimens.
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Affiliation(s)
- Stefano De Luca
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Bollito
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Diletta Garrou
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberta Aimar
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giovanni Cattaneo
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Sabrina De Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Tota
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Massa Federica
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberto Passera
- Department of Nuclear Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
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11
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Muehlematter UJ, Burger IA, Becker AS, Schawkat K, Hötker AM, Reiner CS, Müller J, Rupp NJ, Rüschoff JH, Eberli D, Donati OF. Diagnostic Accuracy of Multiparametric MRI versus 68Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer. Radiology 2019; 293:350-358. [PMID: 31502937 DOI: 10.1148/radiol.2019190687] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Recent studies have reported the additive value of combined gallium 68 (68Ga)-labeled Glu-urea-Lys (Ahx)-HBED-CC ligand targeting the prostate-specific membrane antigen (PSMA) (hereafter called 68Ga-PSMA-11) PET/MRI for the detection and localization of primary prostate cancer compared with multiparametric MRI. Purpose To compare the diagnostic accuracy and interrater agreement of multiparametric MRI and 68Ga-PSMA-11 PET/MRI for the detection of extracapsular extension (ECE) and seminal vesicle infiltration (SVI) in patients with prostate cancer. Materials and Methods Retrospective analysis of 40 consecutive men who underwent multiparametric MRI and 68Ga-PSMA-11 PET/MRI within 6 months for suspected prostate cancer followed by radical prostatectomy between April 2016 and July 2018. Four readers blinded to clinical and histopathologic findings rated the probability of ECE and SVI at multiparametric MRI and PET/MRI by using a five-point Likert-type scale. The prostatectomy specimen served as the reference standard. Accuracy was assessed with a multireader multicase analysis and by calculating reader-average areas under the receiver operating characteristics curve (AUCs), sensitivity, and specificity for ordinal and dichotomized data in a region-specific and patient-specific approach. Interrater agreement was assessed with the Fleiss multirater κ. Results For multiparametric MRI versus PET/MRI in ECE detection, respectively, AUC, sensitivity, and specificity in the region-specific analysis were 0.67 and 0.75 (P = .07), 28% (21 of 76) and 47% (36 of 76) (P = .09), and 94% (529 of 564) and 90% (509 of 564) (P = .007). For the patient-specific analysis, AUC, sensitivity, and specificity were 0.66 and 0.73 (P = .19), 46% (22 of 48) and 69% (33 of 48) (P = .04), and 75% (84 of 112) and 67% (75 of 112) (P = .19), respectively. For multiparametric MRI versus PET/MRI in SVI detection, respectively, AUC, sensitivity, and specificity of the region-specific analysis were 0.66 and 0.74 (P = .21), 35% (seven of 20) and 50% (10 of 20) (P = .25), and 98% (295 of 300) and 94% (282 of 300) (P < .001). For the patient-specific analysis, AUC, sensitivity, and specificity were 0.65 and 0.79 (P = .25), 35% (seven of 20) and 55% (11 of 20) (P = .20), and 98% (137 of 140) and 94% (131 of 140) (P = .07), respectively. Interrater reliability for multiparametric MRI versus PET/MRI did not differ for ECE (κ, 0.46 vs 0.40; P = .24) and SVI (κ, 0.23 vs 0.33; P = .39). Conclusion Our results suggest that gallium 68 (68Ga)-labeled Glu-urea-Lys (Ahx)-HBED-CC ligand targeting the prostate-specific membrane antigen (PSMA) (68Ga-PSMA-11) PET/MRI and multiparametric MRI perform similarly for local staging of prostate cancer in patients with intermediate-to-high-risk prostate cancer. The increased sensitivity of 68Ga-PSMA-11 PET/MRI for the detection of extracapsular disease comes at the cost of a slightly reduced specificity. © RSNA, 2019.
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Affiliation(s)
- Urs J Muehlematter
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Irene A Burger
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Anton S Becker
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Khoschy Schawkat
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Andreas M Hötker
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Cäcilia S Reiner
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Julian Müller
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Niels J Rupp
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Jan H Rüschoff
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Daniel Eberli
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
| | - Olivio F Donati
- From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.)
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Multiparametric MRI - local staging of prostate cancer and beyond. Radiol Oncol 2019; 53:159-170. [PMID: 31103999 PMCID: PMC6572496 DOI: 10.2478/raon-2019-0021] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background Accurate local staging is critical for treatment planning and prognosis in patients with prostate cancer (PCa). The primary aim is to differentiate between organ-confined and locally advanced disease with the latter carrying a worse clinical prognosis. Multiparametric MRI (mpMRI) is the imaging modality of choice for the local staging of PCa and has an incremental value in assessing pelvic nodal disease and bone involvement. It has shown superior performance compared to traditional staging based on clinical nomograms, and provides additional information on the site and extent of disease. MRI has a high specificity for diagnosing extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node (LN) metastases, however, sensitivity remains poor. As a result, extended pelvic LN dissection remains the gold standard for assessing pelvic nodal involvement, and there has been recent progress in developing advanced imaging techniques for more distal staging. Conclusions T2W-weighted imaging is the cornerstone for local staging of PCa. Imaging at 3T and incorporating both diffusion weighted and dynamic contrast enhanced imaging can further increase accuracy. "Next generation" imaging including whole body MRI and PET-MRI imaging using prostate specific membrane antigen (68Ga-PSMA), has shown promising for assessment of LN and bone involvement as compared to the traditional work-up using bone scintigraphy and body CT.
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Goupy F, Supiot S, Pasquier D, Latorzeff I, Schick U, Monpetit E, Martinage G, Hervé C, Le Proust B, Castelli J, de Crevoisier R. Intensity-modulated radiotherapy for prostate cancer with seminal vesicle involvement (T3b): A multicentric retrospective analysis. PLoS One 2019; 14:e0210514. [PMID: 30682036 PMCID: PMC6347455 DOI: 10.1371/journal.pone.0210514] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES No study has reported clinical results of external-beam radiotherapy specifically for T3b prostate cancer. The possibility of escalating the dose to the involved seminal vesicles (ISV) while respecting the dose constraints in the organs at risk is thus so far not clearly demonstrated. The objective of the study was to analyze the dose distribution and the clinical outcome in a large series of patients who received IMRT for T3b prostate cancer. MATERIALS AND METHODS This retrospective analysis included all patients who received IMRT and androgen deprivation therapy for T3b prostate cancer, between 2008 and 2017, in six French institutions, with available MRI images and dosimetric data. RESULTS A total of 276 T3b patients were included. The median follow-up was 26 months. The median (range) prescribed doses (Gy) to the prostate and to the ISV were 77 (70-80) and 76 (46-80), respectively. The dose constraint recommendations were exceeded in less than 12% of patients for the rectum and the bladder. The 5-year risks of biochemical and clinical recurrences and cancer-specific death were 24.8%, 21.7%, and 10.3%, respectively. The 5-year risks of local, pelvic lymph node, and metastatic recurrences were 6.4%, 11.3%, and 15%, respectively. The number of involved lymph nodes (≤ 2 or ≥ 3) on MRI was the only significant prognostic factor in clinical recurrence (HR 9.86) and death (HR 2.78). Grade ≥ 2 acute and 5-year late toxicity rates were 13.2% and 12% for digestive toxicity, and 34% and 31.5% for urinary toxicity, respectively. The dose to the pelvic lymph node and the age were predictive of late digestive toxicity. CONCLUSION IMRT for T3b prostate cancer allows delivery of a curative dose in the ISV, with a moderate digestive toxicity but a higher urinary toxicity. Lymph node involvement increases the risk of recurrence and death.
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Affiliation(s)
- Flora Goupy
- Radiation Department, CLCC Eugène Marquis,Rennes, France
| | | | | | - Igor Latorzeff
- Radiation Department, Clinique Pasteur, Toulouse, France
| | - Ulrike Schick
- Radiation Department, University Hospital Cavale Blanche, Brest, France
| | - Erik Monpetit
- Radiation Department, Clinique Saint-Yves, Vannes, France
| | | | - Chloé Hervé
- Radiation Department, CLCC Eugène Marquis,Rennes, France
| | | | - Joel Castelli
- Radiation Department, CLCC Eugène Marquis,Rennes, France
- University Rennes 1, LTSI (Laboratoire Traitement du Signal et de l'Image), Inserm U1099, Rennes, France
| | - Renaud de Crevoisier
- Radiation Department, CLCC Eugène Marquis,Rennes, France
- University Rennes 1, LTSI (Laboratoire Traitement du Signal et de l'Image), Inserm U1099, Rennes, France
- * E-mail:
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Chaddad A, Niazi T, Probst S, Bladou F, Anidjar M, Bahoric B. Predicting Gleason Score of Prostate Cancer Patients Using Radiomic Analysis. Front Oncol 2018; 8:630. [PMID: 30619764 PMCID: PMC6305278 DOI: 10.3389/fonc.2018.00630] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/04/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose: Use of quantitative imaging features and encoding the intra-tumoral heterogeneity from multi-parametric magnetic resonance imaging (mpMRI) for the prediction of Gleason score is gaining attention as a non-invasive biomarker for prostate cancer (PCa). This study tested the hypothesis that radiomic features, extracted from mpMRI, could predict the Gleason score pattern of patients with PCa. Methods: This analysis included T2-weighted (T2-WI) and apparent diffusion coefficient (ADC, computed from diffusion-weighted imaging) scans of 99 PCa patients from The Cancer Imaging Archive (TCIA). A total of 41 radiomic features were calculated from a local tumor sub-volume (i.e., regions of interest) that is determined by a centroid coordinate of PCa volume, grouped based on their Gleason score patterns. Kruskal-Wallis and Spearman's rank correlation tests were used to identify features related to Gleason score groups. Random forest (RF) classifier model was used to predict Gleason score groups and identify the most important signature among the 41 radiomic features. Results: Gleason score groups could be discriminated based on zone size percentage, large zone size emphasis and zone size non-uniformity values (p < 0.05). These features also showed a significant correlation between radiomic features and Gleason score groups with a correlation value of -0.35, 0.32, 0.42 for the large zone size emphasis, zone size non-uniformity and zone size percentage, respectively (corrected p < 0.05). RF classifier model achieved an average of the area under the curves of the receiver operating characteristic (ROC) of 83.40, 72.71, and 77.35% to predict Gleason score groups (G1) = 6; 6 < (G2) < (3 + 4) and (G3) ≥ 4 + 3, respectively. Conclusion: Our results suggest that the radiomic features can be used as a non-invasive biomarker to predict the Gleason score of the PCa patients.
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Affiliation(s)
- Ahmad Chaddad
- Division of Radiation Oncology, McGill University, Montreal, QC, Canada.,Department of Automated Production Engineering, ETS, Montreal, QC, Canada
| | - Tamim Niazi
- Division of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - Stephan Probst
- Division of Nuclear Medicine, McGill University, Montreal, QC, Canada
| | - Franck Bladou
- Depatment of Urology, McGill University, Montreal, QC, Canada
| | - Maurice Anidjar
- Depatment of Urology, McGill University, Montreal, QC, Canada
| | - Boris Bahoric
- Division of Radiation Oncology, McGill University, Montreal, QC, Canada
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15
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Chen T, Li M, Gu Y, Zhang Y, Yang S, Wei C, Wu J, Li X, Zhao W, Shen J. Prostate Cancer Differentiation and Aggressiveness: Assessment With a Radiomic-Based Model vs. PI-RADS v2. J Magn Reson Imaging 2018; 49:875-884. [PMID: 30230108 PMCID: PMC6620601 DOI: 10.1002/jmri.26243] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 01/08/2023] Open
Abstract
Background Multiparametric MRI (mp‐MRI) combined with machine‐aided approaches have shown high accuracy and sensitivity in prostate cancer (PCa) diagnosis. However, radiomics‐based analysis has not been thoroughly compared with Prostate Imaging and Reporting and Data System version 2 (PI‐RADS v2) scores. Purpose To develop and validate a radiomics‐based model for differentiating PCa and assessing its aggressiveness compared with PI‐RADS v2 scores. Study Type Retrospective. Population In all, 182 patients with biopsy‐proven PCa and 199 patients with a biopsy‐proven absence of cancer were enrolled in our study. Field Strength/Sequence Conventional and diffusion‐weighted MR images (b values = 0, 1000 sec/mm2) were acquired on a 3.0T MR scanner. Assessment A total of 396 features and 385 features were extracted from apparent diffusion coefficient (ADC) images and T2WI, respectively. A predictive model was constructed for differentiating PCa from non‐PCa and high‐grade from low‐grade PCa. The diagnostic performance of each radiomics‐based model was compared with that of the PI‐RADS v2 scores. Statistical Tests A radiomics‐based predictive model was constructed by logistic regression analysis. 70% of the patients were assigned to the training group, and the remaining were assigned to the validation group. The diagnostic efficacy was analyzed with receiver operating characteristic (ROC) in both the training and validation groups. Results For PCa versus non‐PCa, the validation model had an area under the ROC curve (AUC) of 0.985, 0.982, and 0.999 with T2WI, ADC, and T2WI&ADC features, respectively. For low‐grade versus high‐grade PCa, the validation model had an AUC of 0.865, 0.888, and 0.93 with T2WI, ADC, and T2WI&ADC features, respectively. PI‐RADS v2 had an AUC of 0.867 in differentiating PCa from non‐PCa and an AUC of 0.763 in differentiating high‐grade from low‐grade PCa. Data Conclusion Both the T2WI‐ and ADC‐based radiomics models showed high diagnostic efficacy and outperformed the PI‐RADS v2 scores in distinguishing cancerous vs. noncancerous prostate tissue and high‐grade vs. low‐grade PCa. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:875–884.
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Affiliation(s)
- Tong Chen
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Mengjuan Li
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China.,GE Healthcare Life Science, Shanghai, China
| | - Yuefan Gu
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yueyue Zhang
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shuo Yang
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chaogang Wei
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiangfen Wu
- Institute of Radiation Oncology Therapeutics of Soochow University, Suzhou, China
| | - Xin Li
- Institute of Radiation Oncology Therapeutics of Soochow University, Suzhou, China
| | - Wenlu Zhao
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Junkang Shen
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China.,GE Healthcare Life Science, Shanghai, China
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Czarniecki M, Pesapane F, Wood BJ, Choyke PL, Turkbey B. Ultra-small superparamagnetic iron oxide contrast agents for lymph node staging of high-risk prostate cancer. Transl Androl Urol 2018; 7:S453-S461. [PMID: 30363485 PMCID: PMC6178308 DOI: 10.21037/tau.2018.05.15] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Ultrasmall superparamagnetic particles of iron oxide (USPIOs) imaged with magnetic resonance imaging (MRI) have been proposed as an experimental method for visualizing lymph node (LN) metastases. The method does not require ionizing radiation, yet can detect small nodes that are involved with metastases. USPIOs are naturally taken up by macrophages that deposit in the normal LN creating a low signal region in normal areas; areas within the node that do not show this loss of signal are likely involved by tumor although there can be other causes (fibrosis or inflammation). However, the lack of approved USPIOs that are clinically available hinders adoption and larger studies. The proposed indications for USPIO MRI, including specific compounds and imaging methods are discussed.
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Affiliation(s)
- Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Filippo Pesapane
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.,Center for Interventional Oncology, NCI and Radiology Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, NCI and Radiology Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Dix DB, McDonald AM, Gordetsky JB, Nix JW, Thomas JV, Rais-Bahrami S. How Would MRI-targeted Prostate Biopsy Alter Radiation Therapy Approaches in Treating Prostate Cancer? Urology 2018; 122:139-146. [PMID: 30172834 DOI: 10.1016/j.urology.2018.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine if magnetic resonance imaging (MRI)/ultrasound fusion-targeted prostate biopsy (TB) would lead to increased recommendations of aggressive radiotherapy treatments for higher risk prostate cancer compared to systematic biopsy (SB) results. METHODS Clinicopathologic data of 533 men who underwent both TB and SB from 2014 to 2017 was analyzed. TB was performed in addition to SB in patients with detection of MRI suspicious lesions. Three patient cohorts were established: (1) biopsy naïve (80/533, 15.0%), (2) active surveillance (185/533, 34.7%), and (3) prior negative biopsy (268/533, 50.3%). Cancer risk categorical criteria were established with recommended radiotherapy treatment for each. Variation of risk classification due to biopsy method for all patients and within each cohort was analyzed using either a chi-squared statistic or Fisher's exact test. McNemar's pairwise analyses were performed for all risk categories between TB and SB to assess the effects of TB on high-risk cancer identification and subsequent radiotherapy recommendations. RESULTS Number of patients within cancer risk categories (1. "No Cancer or Low-Risk"; 2. "More Favorable Intermediate-Risk"; 3. "Less Favorable Intermediate-Risk"; 4. "High-Risk") varied significantly based on TB and SB pathology among all patients combined (P <.0001), in cohort 2 (P = .0005), and in cohort 3 (P <0.0001). Further, among all patients, TB increased cancer risk classification and correspondingly would result in more aggressive radiotherapy recommendations: "No Cancer or Low-Risk" to "Less Favorable Intermediate-Risk" (30/343, P <0.0001) and "No Cancer or Low-Risk" to "High-Risk" (31/353, P <.0001). CONCLUSION Among men with prostate cancer, TB commonly led to reclassification to a higher risk group, which is accompanied by more aggressive radiotherapy treatment recommendations when compared with SB findings alone.
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Affiliation(s)
- Daniel B Dix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Andrew M McDonald
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.
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19
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Zhang YD, Wang J, Wu CJ, Bao ML, Li H, Wang XN, Tao J, Shi HB. An imaging-based approach predicts clinical outcomes in prostate cancer through a novel support vector machine classification. Oncotarget 2018; 7:78140-78151. [PMID: 27542201 PMCID: PMC5363650 DOI: 10.18632/oncotarget.11293] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/11/2016] [Indexed: 11/29/2022] Open
Abstract
Preoperatively predict the probability of Prostate cancer (PCa) biochemical recurrence (BCR) is of definite clinical relevance. The purpose of this study was to develop an imaging-based approach in the prediction of 3-years BCR through a novel support vector machine (SVM) classification. We collected clinicopathologic and MR imaging datasets in 205 patients pathologically confirmed PCa after radical prostatectomy. Univariable and multivariable analyses were used to assess the association between MR findings and 3-years BCR, and modeled the imaging variables and follow-up data to predict 3-year PCa BCR using SVM analysis. The performance of SVM was compared with conventional Logistic regression (LR) and D'Amico risk stratification scheme by area under the receiver operating characteristic curve (Az) analysis. We found that SVM had significantly higher Az (0.959 vs. 0.886; p = 0.007), sensitivity (93.3% vs. 83.3%; p = 0.025), specificity (91.7% vs. 77.2%; p = 0.009) and accuracy (92.2% vs. 79.0%; p = 0.006) than LR analysis. Performance of popularized D'Amico scheme was effectively improved by adding MRI-derived variables (Az: 0.970 vs. 0.859, p < 0.001; sensitivity: 91.7% vs. 86.7%, p = 0.031; specificity: 94.5% vs. 78.6%, p = 0.001; and accuracy: 93.7% vs. 81.0%, p = 0.007). Additionally, beside pathological Gleason score (hazard ratio [HR] = 1.560, p = 0.008), surgical-T3b (HR = 4.525, p < 0.001) and positive surgical margin (HR = 1.314, p = 0.007), apparent diffusion coefficient (HR = 0.149, p = 0.035) was the only independent imaging predictor of time to PSA failure. Therefore, We concluded that imaging-based approach using SVM was superior to LR analysis in predicting PCa outcome. Adding MR variables improved the performance of D'Amico scheme.
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Affiliation(s)
- Yu-Dong Zhang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jing Wang
- Center for Medical Device Evaluation, CFDA, Beijing, China
| | - Chen-Jiang Wu
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Mei-Ling Bao
- Department of Pathology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hai Li
- Department of Pathology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiao-Ning Wang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jun Tao
- Department of Urology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Ledezma RA. Aportes actuales de la resonancia magnética para el manejo del cáncer de próstata. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Porpiglia F, Manfredi M, Mele F, Bertolo R, Bollito E, Gned D, De Pascale A, Russo F, Passera R, Fiori C, De Luca S. Indication to pelvic lymph nodes dissection for prostate cancer: the role of multiparametric magnetic resonance imaging when the risk of lymph nodes invasion according to Briganti updated nomogram is <5%. Prostate Cancer Prostatic Dis 2018; 21:85-91. [DOI: 10.1038/s41391-017-0026-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/29/2017] [Accepted: 11/17/2017] [Indexed: 12/12/2022]
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Wang J, Wu CJ, Bao ML, Zhang J, Shi HB, Zhang YD. Using support vector machine analysis to assess PartinMR: A new prediction model for organ-confined prostate cancer. J Magn Reson Imaging 2018; 48:499-506. [PMID: 29437268 DOI: 10.1002/jmri.25961] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/19/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jing Wang
- Center for Medical Device Evaluation, CFDA; Beijing China
| | - Chen-Jiang Wu
- Department of Radiology; First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Mei-Ling Bao
- Department of Pathology; First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Jing Zhang
- Department of Radiology; First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Hai-Bin Shi
- Department of Radiology; First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Yu-Dong Zhang
- Department of Radiology; First Affiliated Hospital with Nanjing Medical University; Nanjing China
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Abraham B, Nair MS. Computer-aided diagnosis of clinically significant prostate cancer from MRI images using sparse autoencoder and random forest classifier. Biocybern Biomed Eng 2018. [DOI: 10.1016/j.bbe.2018.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Dirajlal PA, Jambon E, Albat-Esquirou A, Galmiche C, Bernhard JC, Grenier N, Haaser T, Cornelis FH. T2 Star-weighted Angiography (SWAN) Allows to Concomitantly Assess the Prostate Contour While Detecting Fiducials Before MR-based Intensity-modulated Radiation Therapy in Prostate Carcinoma. Acad Radiol 2018; 25:95-101. [PMID: 28844603 DOI: 10.1016/j.acra.2017.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the performance of T2 star-weighted angiography (SWAN) to concomitantly assess the prostate contour while detecting fiducials before magnetic resonance (MR)-based intensity-modulated radiation therapy (IMRT) in prostate carcinoma. MATERIALS AND METHODS Forty patients (mean age: 73.1 ± 7.5 years; average Gleason score: 7 ± 1; average prostate-specific antigen: 14.7 ± 11.6 ng/mL) underwent MR and computed tomography imaging before fiducial-based IMRT. MR protocol included SWAN, T2-weighted (T2w) and diffusion-weighted imaging in a first group (n = 20) and SWAN, T2w and T2-star weighted imaging in a second group (n = 20). In group 1, the depiction of fiducials, image sharpness and visibility of prostate boundaries were independently evaluated by 2 readers on SWAN, T2w or diffusion-weighted images. In group 2, a similar evaluation was performed by 2 other readers on SWAN and T2-star images only. Depiction of fiducials was compared to computed tomography findings. RESULTS The median scores of visibility of prostate boundaries, image sharpness and depiction of fiducials by SWAN were above average to excellent for all readers. In group 1, readers correctly located 56 of 57 (98.2%) and 47 of 57 (82.5%) fiducials, respectively; and 50 of 51 (98%), and 48 of 51 (88.2%) fiducials in group 2, respectively. CONCLUSION By allowing adequate visualization of the prostate boundaries and high depiction of fiducial markers concomitantly, SWAN might be used for treatment planning of IMRT. The use of this sequence might simplify the registration process and limit any errors associated with image fusion.
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Affiliation(s)
| | - Eva Jambon
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Agnes Albat-Esquirou
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Chloe Galmiche
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | | | - Nicolas Grenier
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Thibaud Haaser
- Department of Oncology, St André Hospital, Bordeaux, France
| | - François H Cornelis
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France; Department of Radiology, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France.
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Seminal vesicle invasion on multi-parametric magnetic resonance imaging: Correlation with histopathology. Eur J Radiol 2017; 98:107-112. [PMID: 29279147 DOI: 10.1016/j.ejrad.2017.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/11/2017] [Accepted: 11/17/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The pre-treatment risk of seminal vesicle (SV) invasion (SVI) from prostate cancer is currently based on nomograms which include clinical stage (cT), Gleason score (GS) and prostate-specific antigen (PSA). The aim of our study was to evaluate the staging accuracy of 3T (3T) multi-parametric (mp) Magnetic Resonance Imaging (MRI) by comparing the imaging report of SVI with the tissue histopathology. The additional value in the existing prediction models and the role of radiologists' experience were also examined. METHODS After obtaining institutional review board approval, we retrospectively reviewed clinico-pathological data from 527 patients who underwent a robot-assisted radical prostatectomy (RARP) between January 2012 and March 2015. Preoperative prostate imaging with an endorectal 3T-mp-MRI was performed in all patients. Sequences consisted of an axial pre-contrast T1 sequence, three orthogonally-oriented T2 sequences, axial diffusion weighted and dynamic contrast-enhanced sequences. We considered SVI in case of low-signal intensity in the SV on T2-weighted sequences or apparent mass while diffusion-weighted and DCE sequences were used to confirm findings on T2. Whole-mount section pathology was performed in all patients. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI (index test) for the prediction of histological SVI (reference standard) were calculated. We developed logistic multivariable regression models including: clinical variables (PSA, cT, percentage of involved cores/total cores, primary GS 4-5) and Partin table estimates. MRI results (negative/positive exam) were then added in the models and the multivariate modeling was reassessed. In order to assess the extent of SVI and the reason for mismatch with pathology an MRI-review from an expert genitourinary radiologist was performed in a subgroup of 379 patients. RESULTS A total of 54 patients (10%) were found to have SVI on RARP-histopathology. In the overall cohort sensitivity, specificity, PPV and NPV for SVI detection on MRI were 75.9%, 94.7%, 62% and 97% respectively. Based on our sub-analysis, the radiologist's expertise improved the accuracy demonstrating a sensitivity, specificity, PPV and NPV of 85.4%, 95.6%, 70.0% and 98.2%, respectively. In the multivariate analysis PSA (odds ratio [OR] 1.07, p=0.008), primary GS 4 or 5 (OR 3.671, p=0.007) and Partin estimates (OR 1.07, p=0.023) were significant predictors of SVI. When MRI results were added to the analysis, a highly significant prediction of SVI was observed (OR 45.9, p<0.0001). Comparing Partin, MRI and Partin with MRI predictive models, the areas under the curve were 0.837, 0.884 and 0.929, respectively. CONCLUSIONS MRI had high diagnostic accuracy for SVI on histopathology. It provided added diagnostic value to clinical/Partin based SVI-prediction models alone. A key factor is radiologist's experience, though no inter-observer variability could be examined due to the availability of a single expert radiologist.
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Yang DD, Muralidhar V, Nguyen PL, Buzurovic I, Martin NE, Mouw KW, Devlin PM, Trinh QD, Orio PF, King MT. Lack of Benefit From the Addition of External Beam Radiation Therapy to Brachytherapy for Intermediate- and High-risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2017; 99:904-911. [PMID: 29063853 DOI: 10.1016/j.ijrobp.2017.07.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/11/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE A recent randomized controlled trial demonstrated that the addition of external beam radiation therapy (EBRT) to brachytherapy did not improve progression-free survival in select patients with intermediate-risk prostate cancer. We evaluated whether the addition of EBRT to brachytherapy improves prostate cancer-specific mortality (PCSM) for intermediate- and high-risk disease using a large national database. METHODS AND MATERIALS We identified 5836 patients in the Surveillance, Epidemiology, and End Results-Medicare linked database with a diagnosis of National Comprehensive Cancer Network intermediate-risk (Gleason score 7, prostate-specific antigen 10-20 ng/mL, or stage cT2b-T2c) or high-risk (Gleason score 8-10 or prostate-specific antigen >20 ng/mL and stage ≤cT3a) prostate cancer who had undergone brachytherapy, with or without EBRT and androgen deprivation therapy (ADT). Patients were diagnosed from 2004 through 2009. Intermediate-risk patients with Gleason score ≤3+4 and 1 intermediate-risk factor were considered favorable and all others unfavorable. We used multivariable Fine-Gray competing risks regression to study PCSM while adjusting for sociodemographic and clinical factors and ADT use. RESULTS Overall, 50.3% of intermediate- and high-risk patients who received brachytherapy and EBRT did not have significantly improved PCSM compared with that of the patients who received brachytherapy alone (adjusted hazard ratio [AHR] 1.46, 95% confidence interval [CI] 0.69-3.11; P=.322; 5-year PCSM 2.4% vs 1.0%). This lack of benefit was seen among favorable intermediate-risk (AHR 2.66, 95% CI 0.93-7.62, P=.069; 5-year PCSM 1.3% vs 0.6%), unfavorable intermediate-risk (AHR 0.68, 95% CI 0.16-2.96, P=.612; 5-year PCSM 1.0% vs 1.2%), and high-risk (AHR 1.82, 95% CI 0.67-4.98, P=.242; 5-year PCSM 5.3% vs 2.1%) subgroups. CONCLUSIONS These results suggest that certain patients with intermediate- or high-risk prostate cancer treated with brachytherapy might not benefit from the addition of EBRT. A randomized controlled trial of brachytherapy plus ADT with or without EBRT for unfavorable intermediate- and favorable high-risk organ-confined prostate cancer should be undertaken.
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Affiliation(s)
- David D Yang
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vinayak Muralidhar
- Harvard Medical School, Boston, Massachusetts; Harvard Radiation Oncology Program, Boston, Massachusetts
| | - Paul L Nguyen
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ivan Buzurovic
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Neil E Martin
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kent W Mouw
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Phillip M Devlin
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Harvard Medical School, Boston, Massachusetts; Division of Urological Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter F Orio
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Martin T King
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
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Current Role of Magnetic Resonance Imaging in Prostate Cancer. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0255-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tsumura H, Ishiyama H, Tabata KI, Katsumata H, Kobayashi M, Ikeda M, Kurosaka S, Fujita T, Kitano M, Satoh T, Yanagisawa N, Hayakawa K, Iwamura M. Impact of five-tiered Gleason grade groups on prognostic prediction in clinical stage T3 prostate cancer undergoing high-dose-rate brachytherapy. Prostate 2017; 77:1520-1527. [PMID: 28905446 DOI: 10.1002/pros.23430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 08/31/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND We evaluated a five-tiered Gleason grade groups arising from the 2014 International Society of Urological Pathology consensus conference on prognostic prediction in clinical stage T3a (extracapsular invasion) and T3b (seminal vesicle involvement) prostate cancer undergoing high-dose-rate brachytherapy (HDR-BT). METHODS From November 2003 to December 2012, 283 patients with stage T3 prostate cancer received HDR-BT and external beam radiation therapy (EBRT) with long-term androgen deprivation therapy (ADT). Of these, 203 (72%) and 80 (28%) patients had stage T3a and T3b disease, respectively. The mean dose to 90% of the planning target volume was 7.5 Gy/fraction of HDR-BT. After five fractions, EBRT with 10 fractions of 3 Gy was administered. All patients first underwent ≥6 months of neoadjuvant ADT, and adjuvant ADT continued for 36 months. Median follow-up was 74 months from the start of radiotherapy. RESULTS The 10-year biochemical recurrence (BCR) -free rate for stage T3a and T3b disease was 79% and 64%, respectively (P = 0.0083). The 10-year cancer-specific survival (CSS) rate for stage T3a and T3b was 96% and 91%, respectively (P = 0.0305). Although grade groups ≥4 were independent predictors for BCR in cT3a patients (P = 0.0270), they failed to significantly predict prostate cancer-specific mortality (PCSM) among cT3a patients. Among cT3b patients, grade group 5 was a significant predictor of both BCR (P = 0.0017) and PCSM (P = 0.0233). Among stage T3a patients, no significant difference existed in 10-year CSS between grade groups 5 and 4 (94% vs 97%, P = 0.3960). In contrast, grade group 5 had a significantly worse outcome in 10-year CSS than grade group 4 among stage T3b patients (74% vs 100%, P = 0.0350). CONCLUSIONS Stage T3a patients with grade groups 4/5 and stage T3b with grade group 4 had fairly low PCSM risk. Approximately one of four patients among stage T3b patients with grade group 5 showed PCSM after combined HDR-BT and EBRT with long-term ADT. Stage T3b patients with grade group 5 may have a greater risk for PCSM.
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Affiliation(s)
- Hideyasu Tsumura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiromichi Ishiyama
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ken-Ichi Tabata
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroki Katsumata
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Momoko Kobayashi
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaomi Ikeda
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shinji Kurosaka
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tetsuo Fujita
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masashi Kitano
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takefumi Satoh
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Nobuyuki Yanagisawa
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Pathology, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Kazushige Hayakawa
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
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Abstract
Prostate cancer is the most common male malignant tumor in Germany, which thus places growing demands on differentiated imaging and risk-adapted therapeutic approaches. Multiparametric MRI (mpMRI) of the prostate enables reliable detection of clinically significant cancers and is currently the leading imaging modality for the detection, characterization, and local staging of prostate cancer. According to the German S3 guideline, mpMRI of the prostate is currently primarily recommended in patients with previous negative TRUS biopsies and persisting tumor suspicion. The serial use of mpMRI in the pretherapeutic setting can support individual therapy planning of patients with locally advanced prostate cancer in the near future.
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30
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[Indications and limits of ablative therapies in prostate cancer]. Prog Urol 2017; 27:865-886. [PMID: 28918871 DOI: 10.1016/j.purol.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/04/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To perform a state of the art about indications and limits of ablative therapies for localized prostate cancer. METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 107 articles were analysed. RESULTS The objective to combine reduction of side effects and oncological control has induced recent development of several ablative therapies. Beyond this heterogeneity, some preferential indications appear: unilateral cancer of low risk (but with significant volume, excluding active surveillance) or intermediate risk (excluding majority of grade 4); treatment targeted the index lesion, by quarter or hemi-ablation, based on biopsy and mpMRI. In addition, indications must considered specific limits of each energy, such as gland volume and tumor localization. CONCLUSION Based on new imaging and biopsy, ablative therapies will probably increased its role in the future in management of localize prostate cancer. The multiple ongoing trials will certainly be helpful to better define their indications and limits.
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Loggitsi D, Gyftopoulos A, Economopoulos N, Apostolaki A, Kalogeropoulos T, Thanos A, Alexopoulou E, Kelekis NL. Multiparametric Magnetic Resonance Imaging of the Prostate for Tumour Detection and Local Staging: Imaging in 1.5T and Histopathologic Correlation. Can Assoc Radiol J 2017; 68:379-386. [PMID: 28720413 DOI: 10.1016/j.carj.2017.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 12/10/2016] [Accepted: 02/05/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The study sought to prospectively evaluate which technique among T2-weighted images, dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), diffusion-weighted (DW) MRI, or a combination of the 2, is best suited for prostate cancer detection and local staging. METHODS Twenty-seven consecutive patients with biopsy-proven adenocarcinoma of the prostate underwent MRI on a 1.5T scanner with a surface phased-array coil prior radical prostatectomy. Combined anatomical and functional imaging was performed with the use of T2-weighted sequences, DCE MRI, and DW MRI. We compared the imaging results with whole mount histopathology. RESULTS For the multiparametric approach, significantly higher sensitivity values, that is, 53% (95% confidence interval [CI]: 41.0-64.1) were obtained as compared with each modality alone or any combination of the 3 modalities (P < .05). The specificity for this multiparametric approach, being 90.3% (95% CI: 86.3-93.3) was not significantly higher (P < .05) as compared with the values of the combination of T2+DCE MRI, DW+DCE MRI, or DCE MRI alone. Among the 3 techniques, DCE had the best performance for tumour detection in both the peripheral and the transition zone. High negative predictive value rates (>86%) were obtained for both tumour detection and local staging. CONCLUSIONS The combination of T2-weighted sequences, DCE MRI, and DW MRI yields higher diagnostic performance for tumour detection and local staging than can any of these techniques alone or even any combination of them.
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Affiliation(s)
- Dimitra Loggitsi
- Second Department of Radiology, General University Hospital Attikon, Haidari, Athens, Greece
| | - Anastasios Gyftopoulos
- Second Department of Radiology, General University Hospital Attikon, Haidari, Athens, Greece.
| | - Nikolaos Economopoulos
- Second Department of Radiology, General University Hospital Attikon, Haidari, Athens, Greece
| | | | | | - Anastasios Thanos
- Urology Department, St Savvas Anticancer and Oncology Hospital, Athens, Greece
| | - Efthimia Alexopoulou
- Second Department of Radiology, General University Hospital Attikon, Haidari, Athens, Greece
| | - Nikolaos L Kelekis
- Second Department of Radiology, General University Hospital Attikon, Haidari, Athens, Greece
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Multiparametric MR Imaging for Detection and Locoregional Staging of Prostate Cancer. Top Magn Reson Imaging 2017; 25:109-17. [PMID: 27187165 DOI: 10.1097/rmr.0000000000000089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Detection and staging of prostate cancer (PCa) based on digital rectal examination, prostate-specific antigen levels, and systematic transrectal ultrasound-guided biopsies show notorious limitations in light of the current needs of PCa management. Multiparametric magnetic resonance imaging (mpMRI) has emerged as a useful noninvasive imaging technique for detection, staging, assessment of aggressiveness, and treatment monitoring of PCa, combining anatomic high-resolution T2-weighted images with functional techniques, such as diffusion-weighted imaging and dynamic contrast enhancement evaluation. In this article, the authors review the technical aspects and the current clinical role of mpMRI for detection and locoregional staging of PCa.
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Wang J, Wu CJ, Bao ML, Zhang J, Wang XN, Zhang YD. Machine learning-based analysis of MR radiomics can help to improve the diagnostic performance of PI-RADS v2 in clinically relevant prostate cancer. Eur Radiol 2017; 27:4082-4090. [PMID: 28374077 DOI: 10.1007/s00330-017-4800-5] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/13/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate whether machine learning-based analysis of MR radiomics can help improve the performance PI-RADS v2 in clinically relevant prostate cancer (PCa). METHODS This IRB-approved study included 54 patients with PCa undergoing multi-parametric (mp) MRI before prostatectomy. Imaging analysis was performed on 54 tumours, 47 normal peripheral (PZ) and 48 normal transitional (TZ) zone based on histological-radiological correlation. Mp-MRI was scored via PI-RADS, and quantified by measuring radiomic features. Predictive model was developed using a novel support vector machine trained with: (i) radiomics, (ii) PI-RADS scores, (iii) radiomics and PI-RADS scores. Paired comparison was made via ROC analysis. RESULTS For PCa versus normal TZ, the model trained with radiomics had a significantly higher area under the ROC curve (Az) (0.955 [95% CI 0.923-0.976]) than PI-RADS (Az: 0.878 [0.834-0.914], p < 0.001). The Az between them was insignificant for PCa versus PZ (0.972 [0.945-0.988] vs. 0.940 [0.905-0.965], p = 0.097). When radiomics was added, performance of PI-RADS was significantly improved for PCa versus PZ (Az: 0.983 [0.960-0.995]) and PCa versus TZ (Az: 0.968 [0.940-0.985]). CONCLUSION Machine learning analysis of MR radiomics can help improve the performance of PI-RADS in clinically relevant PCa. KEY POINTS • Machine-based analysis of MR radiomics outperformed in TZ cancer against PI-RADS. • Adding MR radiomics significantly improved the performance of PI-RADS. • DKI-derived Dapp and Kapp were two strong markers for the diagnosis of PCa.
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Affiliation(s)
- Jing Wang
- Center for Medical Device Evaluation, CFDA, Beijing, China, 100044
| | - Chen-Jiang Wu
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, 300, Guangzhou Road, Nanjing, Jiangsu Province, China, 210009
| | - Mei-Ling Bao
- Department of Pathology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China, 210009
| | - Jing Zhang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, 300, Guangzhou Road, Nanjing, Jiangsu Province, China, 210009
| | - Xiao-Ning Wang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, 300, Guangzhou Road, Nanjing, Jiangsu Province, China, 210009
| | - Yu-Dong Zhang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, 300, Guangzhou Road, Nanjing, Jiangsu Province, China, 210009.
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Abstract
Locally advanced prostate cancer (LAPCA) comprises about 5-10 % of all newly diagnosed prostate cancers and is associated with the highest prostate cancer specific mortality (approximately 8-20 %). LAPCA is defined by the presence of extraprostatic extension, seminal vesicle invasion, and bladder neck infiltration of pelvic lymph node metastases. It is evident that prognosis can only be improved by interdisciplinary multimodality treatment strategies. Adequate local staging by multiparametric MRI is one of the cornerstones for an individualized, risk-adapted treatment approach. This might consist of extended radical prostatectomy with an extended pelvic lymphadenectomy or intensity-modulated radiation therapy with androgen deprivation as the primary local therapeutic approach. Both treatment strategies may be combined with neoadjuvant or adjuvant radiation therapy or salvage surgery. Combination with neoadjuvant or adjuvant chemotherapy and new androgen receptor pathway inhibitors might also be possible. This article summarizes the current treatment strategies for LAPCA.
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Affiliation(s)
- A Heidenreich
- Klinik für Urologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - D Böhmer
- Klinik für Radioonkologie und Strahlentherapie, Charité Campus Benjamin Franklin, Berlin, Deutschland
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35
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Abstract
This review article aims to provide an overview on of diffusion-weighted MR imaging (DW-MR imaging) in the urogenital tract. Compared with conventional cross-sectional imaging methods, the additional value of DW-MR imaging in the detection and further characterization of benign and malignant lesions of the kidneys, bladder, prostate, and pelvic lymph nodes is discussed as well as the role of DW-MR imaging in the evaluation of treatment response.
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Affiliation(s)
- Martin H Maurer
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland
| | - Kirsi Hannele Härmä
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland
| | - Harriet Thoeny
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland.
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McCammack KC, Raman SS, Margolis DJA. Imaging of local recurrence in prostate cancer. Future Oncol 2016; 12:2401-2415. [DOI: 10.2217/fon-2016-0122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Diagnosis of prostate cancer (PCa) recurrence after therapy with curative intent currently depends primarily on biochemical serum analyses. When recurrence is suspected, further treatment decisions rely heavily on the confirmation of disease presence and determination of its extent. This is complicated by the fact that benign conditions can mimic biochemical recurrence, and serum studies do not reliably discriminate between local and distant recurrence. This review discusses the contemporary imaging paradigm for the evaluation of local PCa recurrence. The multidisciplinary implications for urologists, radiation oncologists and radiologists are examined. Emerging techniques and future directions of PCa imaging research are discussed.
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Affiliation(s)
- Kevin C McCammack
- Department of Radiology, University of California Los Angeles Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Steven S Raman
- Department of Radiology, University of California Los Angeles Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Daniel JA Margolis
- Department of Radiology, University of California Los Angeles Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA
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Salerno J, Finelli A, Morash C, Morgan SC, Power N, Schieda N, Haider MA. Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline. Can Urol Assoc J 2016; 10:E332-E339. [PMID: 27800062 DOI: 10.5489/cuaj.3823] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The utility of T2-weighted magnetic resonance imaging (MRI) in the local staging of prostate cancer is controversial. Due to the success of multiparametric MRI in cancer localization, there is renewed interested in MRI (± functional sequences) for local staging. Guidance on pre-treatment local staging of prostate cancer by MRI was developed using systematic review methodology and expert consultation. METHODS MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and other databases were searched to identify studies comparing: (1) MRI staging vs. radical prostatectomy staging on diagnostic accuracy outcomes; and (2) MRI staging vs. routine clinical staging on clinical and patient outcomes. Studies meeting inclusion criteria were synthesized by outcome and sensitivity/specificity analysis by tumour location was performed. Evidence quality of included studies was assessed and considered in recommendation formulation. RESULTS The literature search identified 2510 citations; 62 studies were included. Analysis of MRI ≥1.5 T plus endorectal coil (ER) (± functional sequences) in the detection of extraprostatic extension or seminal vesicle invasion showed modest sensitivities (≥50%) and excellent specificities (>85%) among patients scheduled for radical prostatectomy. MRI upstaging was shown in 20/21 studies, with large variation in correctness (11-85%). Scarcity of clinical and patient outcomes among studies limited synthesis and evaluation. Quality assessment found non-trivial biases. CONCLUSIONS Modest imaging performance was shown for MRI (1.5 T + ER and 3 T ± ER) ± functional sequences in regards to sensitivity. Limitations in study design, reporting of clinical and patient outcomes, and the heterogeneous use of MRI tempered the strength of the recommendations.
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Affiliation(s)
- Jennifer Salerno
- McMaster University, Department of Oncology and Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON, Canada
| | | | | | | | | | - Nichola Schieda
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Masoom A Haider
- Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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Zhang YD, Wu CJ, Bao ML, Li H, Wang XN, Liu XS, Shi HB. MR-based prognostic nomogram for prostate cancer after radical prostatectomy. J Magn Reson Imaging 2016; 45:586-596. [PMID: 27654116 DOI: 10.1002/jmri.25441] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yu-Dong Zhang
- Department of Radiology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Chen-Jiang Wu
- Department of Radiology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Mei-Ling Bao
- Department of Pathology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Hai Li
- Department of Pathology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Xiao-Ning Wang
- Department of Radiology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Xi-Sheng Liu
- Department of Radiology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
| | - Hai-Bin Shi
- Department of Radiology; the First Affiliated Hospital with Nanjing Medical University; Nanjing China
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de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol 2016. [DOI: 10.1016/j.eururo.2015.07.029] [Citation(s) in RCA: 366] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Watson MJ, George AK, Maruf M, Frye TP, Muthigi A, Kongnyuy M, Valayil SG, Pinto PA. Risk stratification of prostate cancer: integrating multiparametric MRI, nomograms and biomarkers. Future Oncol 2016; 12:2417-2430. [PMID: 27400645 DOI: 10.2217/fon-2016-0178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Accurate risk stratification of prostate cancer is achieved with a number of existing tools to ensure the identification of at-risk patients, characterization of disease aggressiveness, prediction of cancer burden and extrapolation of treatment outcomes for appropriate management of the disease. Statistical tables and nomograms using classic clinicopathological variables have long been the standard of care. However, the introduction of multiparametric MRI, along with fusion-guided targeted prostate biopsy and novel biomarkers, are being assimilated into clinical practice. The majority of studies to date present the outcomes of each in isolation. The current review offers a critical and objective assessment regarding the integration of multiparametric MRI and fusion-guided prostate biopsy with novel biomarkers and predictive nomograms in contemporary clinical practice.
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Affiliation(s)
- Matthew J Watson
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Arvin K George
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Mahir Maruf
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Thomas P Frye
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Akhil Muthigi
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Michael Kongnyuy
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Subin G Valayil
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urological Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
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Pilot Study of the Use of Hybrid Multidimensional T2-Weighted Imaging-DWI for the Diagnosis of Prostate Cancer and Evaluation of Gleason Score. AJR Am J Roentgenol 2016; 207:592-8. [PMID: 27352026 DOI: 10.2214/ajr.15.15626] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of our study was to evaluate the role of a hybrid T2-weighted imaging-DWI sequence for prostate cancer diagnosis and differentiation of aggressive prostate cancer from nonaggressive prostate cancer. MATERIALS AND METHODS Twenty-one patients with prostate cancer who underwent preoperative 3-T MRI and prostatectomy were included in this study. Patients underwent a hybrid T2-weighted imaging-DWI examination consisting of DW images acquired with TEs of 47, 75, and 100 ms and b values of 0 and 750 s/mm(2). The apparent diffusion coefficient (ADC) and T2 were calculated for cancer and normal prostate ROIs at each TE and b value. Changes in ADC and T2 as a function of increasing the TE and b value, respectively, were analyzed. A new metric termed "PQ4" was defined as the percentage of voxels within an ROI that has increasing T2 with increasing b value and has decreasing ADC with increasing TE. RESULTS ADC values were significantly higher in normal ROIs than in cancer ROIs at all TEs (p < 0.0001). With increasing TE, the mean ADC increased 3% in cancer ROIs and increased 12% in normal ROIs. T2 was significantly higher in normal ROIs than in cancer ROIs at both b values (p ≤ 0.0002). The mean T2 decreased with increasing b value in cancer ROIs (ΔT2 = -17 ms) and normal ROIs (ΔT2 = -52 ms). PQ4 clearly differentiated normal ROIs from prostate cancer ROIs (p = 0.0004) and showed significant correlation with Gleason score (ρ = 0.508, p < 0.0001). CONCLUSION Hybrid MRI measures the response of ADC and T2 to changing TEs and b values, respectively. This approach shows promise for detecting prostate cancer and determining its aggressiveness noninvasively.
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Radiotherapy Boost for the Dominant Intraprostatic Cancer Lesion—A Systematic Review and Meta-Analysis. Clin Genitourin Cancer 2016; 14:189-97. [DOI: 10.1016/j.clgc.2015.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/24/2015] [Accepted: 12/09/2015] [Indexed: 12/14/2022]
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Van Holsbeeck A, Degroote A, De Wever L, Vanhoutte E, De Keyzer F, Van Poppel H, Oyen R. Staging of prostatic carcinoma at 1.5-T MRI: correlation of a simplified MRI exam with whole-mount radical prostatectomy specimens. Br J Radiol 2016; 89:20160101. [PMID: 27181821 DOI: 10.1259/bjr.20160101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To retrospectively analyze the accuracy of simplified multiparametric MRI at 1.5 T for local staging by using whole-mount-section histopathological analysis as the standard of reference. METHODS 123 consecutive patients underwent T2 weighted, T1 weighted and diffusion-weighted MRI without endorectal coil prior to radical prostatectomy. The accuracy of predicting extracapsular extension (ECE) (T3a) was assessed using direct signs or the combination of direct and indirect signs of extraprostatic extension. The accuracy of predicting seminal vesicle invasion (T3b) was evaluated, taking into account different routes of seminal vesicle involvement. Finally, adjacent organ invasion (T4) was evaluated in this patient population. RESULTS Histopathology showed T3a, T3b and T4 in 61, 28 and 9 cases, respectively. The use of direct signs of extraprostatic extension showed a sensitivity of 57.4% and specificity of 91.9%. The combination of direct signs and indirect signs improved sensitivity (85.2%) at the expense of moderate loss of specificity (83.9%). MR sensitivity for the detection of seminal vesicle invasion was low (53.6%); however, it was dependent on the route of seminal vesicle tumour infiltration. MR sensitivity and specificity for adjacent organ invasion were 88.9% and 99.1%. CONCLUSION Simplified MRI study at 1.5 T provides a relatively high sensitivity for detecting ECE (T3a) when using the combination of indirect and direct signs. However, this high sensitivity reading is at the cost of a moderate loss of specificity. Invasion of the seminal vesicles (T3b) occurs most often along the ejaculatory duct complex with low MR sensitivity. ADVANCES IN KNOWLEDGE Simplified MRI study at 1.5 T without endorectal coil could be used for the local T staging of prostate cancer.
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Affiliation(s)
| | - Annemarie Degroote
- 2 Department of Histopathology, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth De Wever
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Els Vanhoutte
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Raymond Oyen
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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McCammack KC, Schenker-Ahmed NM, White NS, Best SR, Marks RM, Heimbigner J, Kane CJ, Parsons JK, Kuperman JM, Bartsch H, Desikan RS, Rakow-Penner RA, Liss MA, Margolis DJA, Raman SS, Shabaik A, Dale AM, Karow DS. Restriction spectrum imaging improves MRI-based prostate cancer detection. Abdom Radiol (NY) 2016; 41:946-53. [PMID: 26910114 DOI: 10.1007/s00261-016-0659-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To compare the diagnostic performance of restriction spectrum imaging (RSI), with that of conventional multi-parametric (MP) magnetic resonance imaging (MRI) for prostate cancer (PCa) detection in a blinded reader-based format. METHODS Three readers independently evaluated 100 patients (67 with proven PCa) who underwent MP-MRI and RSI within 6 months of systematic biopsy (N = 67; 23 with targeting performed) or prostatectomy (N = 33). Imaging was performed at 3 Tesla using a phased-array coil. Readers used a five-point scale estimating the likelihood of PCa present in each prostate sextant. Evaluation was performed in two separate sessions, first using conventional MP-MRI alone then immediately with MP-MRI and RSI in the same session. Four weeks later, another scoring session used RSI and T2-weighted imaging (T2WI) without conventional diffusion-weighted or dynamic contrast-enhanced imaging. Reader interpretations were then compared to prostatectomy data or biopsy results. Receiver operating characteristic curves were performed, with area under the curve (AUC) used to compare across groups. RESULTS MP-MRI with RSI achieved higher AUCs compared to MP-MRI alone for identifying high-grade (Gleason score greater than or equal to 4 + 3=7) PCa (0.78 vs. 0.70 at the sextant level; P < 0.001 and 0.85 vs. 0.79 at the hemigland level; P = 0.04). RSI and T2WI alone achieved AUCs similar to MP-MRI for high-grade PCa (0.71 vs. 0.70 at the sextant level). With hemigland analysis, high-grade disease results were similar when comparing RSI + T2WI with MP-MRI, although with greater AUCs compared to the sextant analysis (0.80 vs. 0.79). CONCLUSION Including RSI with MP-MRI improves PCa detection compared to MP-MRI alone, and RSI with T2WI achieves similar PCa detection as MP-MRI.
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Affiliation(s)
- Kevin C McCammack
- Department of Radiology, University of California San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA, 92103, USA
| | - Natalie M Schenker-Ahmed
- Department of Radiology, University of California San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA, 92103, USA
| | - Nathan S White
- Department of Radiology, University of California San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA, 92103, USA
| | - Shaun R Best
- Department of Radiology, University of California San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA, 92103, USA
| | - Robert M Marks
- Department of Radiology, Naval Medical Center San Diego, San Diego, USA
| | - Jared Heimbigner
- Department of Radiology, Naval Medical Center San Diego, San Diego, USA
| | - Christopher J Kane
- Department of Urology, University of California San Diego School of Medicine, San Diego, USA
| | - J Kellogg Parsons
- Department of Urology, University of California San Diego School of Medicine, San Diego, USA
| | - Joshua M Kuperman
- Department of Radiology, University of California San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA, 92103, USA
| | - Hauke Bartsch
- Department of Radiology, University of California San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA, 92103, USA
| | - Rahul S Desikan
- Department of Radiology, University of California San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA, 92103, USA
| | - Rebecca A Rakow-Penner
- Department of Radiology, University of California San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA, 92103, USA
| | - Michael A Liss
- Department of Urology, University of Texas San Antonio School of Medicine, San Antonio, USA
| | - Daniel J A Margolis
- Department of Radiology, University of California Los Angeles Geffen School of Medicine, Los Angeles, USA
| | - Steven S Raman
- Department of Radiology, University of California Los Angeles Geffen School of Medicine, Los Angeles, USA
| | - Ahmed Shabaik
- Department of Pathology, University of California San Diego School of Medicine, San Diego, USA
| | - Anders M Dale
- Department of Radiology, University of California San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA, 92103, USA
- Department of Neurosciences, University of California San Diego School of Medicine, San Diego, USA
| | - David S Karow
- Department of Radiology, University of California San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA, 92103, USA.
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Abstract
The diagnosis and treatment of prostate cancer continue to evolve with advances in science and technology. The utilization of multiparametric MRI (mp-MRI) to identify lesions in the prostate has given clinicians the ability to visualize malignancy in the prostate with greater confidence. With this new ability came the advancement of fusion biopsy platforms, which allow for direct targeting of these lesions. As with any new technology in medicine, the proper use of these modalities and how they fit into current clinical practice need to be addressed. This review summarizes the current knowledge on how to best optimize which men undergo mp-MRI and fusion biopsies both in the screening and treatment settings.
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Felker ER, Margolis DJ, Nassiri N, Marks LS. Prostate cancer risk stratification with magnetic resonance imaging. Urol Oncol 2016; 34:311-9. [PMID: 27040381 DOI: 10.1016/j.urolonc.2016.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/22/2016] [Accepted: 03/01/2016] [Indexed: 01/13/2023]
Abstract
In recent years, multiparametric magnetic resonance imaging (mpMRI) has shown promise for prostate cancer (PCa) risk stratification. mpMRI, often followed by targeted biopsy, can be used to confirm low-grade disease before enrollment in active surveillance. In patients with intermediate or high-risk PCa, mpMRI can be used to inform surgical management. mpMRI has sensitivity of 44% to 87% for detection of clinically significant PCa and negative predictive value of 63% to 98% for exclusion of significant disease. In addition to tumor identification, mpMRI has also been shown to contribute significant incremental value to currently used clinical nomograms for predicting extraprostatic extension. In combination with conventional clinical criteria, accuracy of mpMRI for prediction of extraprostatic extension ranges from 92% to 94%, significantly higher than that achieved with clinical criteria alone. Supplemental sequences, such as diffusion-weighted imaging and dynamic contrast-enhanced imaging, allow quantitative evaluation of cancer-suspicious regions. Apparent diffusion coefficient appears to be an independent predictor of PCa aggressiveness. Addition of apparent diffusion coefficient to Epstein criteria may improve sensitivity for detection of significant PCa by as much as 16%. Limitations of mpMRI include variability in reporting, underestimation of PCa volume and failure to detect clinically significant disease in a small but significant number of cases.
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Affiliation(s)
- Ely R Felker
- Department of Radiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Daniel J Margolis
- Department of Radiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Nima Nassiri
- Department of Urology, David Geffen School of Medicine, Los Angeles, CA
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, Los Angeles, CA.
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The role of multi-parametric MRI in loco-regional staging of men diagnosed with early prostate cancer. Curr Opin Urol 2015; 25:510-7. [DOI: 10.1097/mou.0000000000000215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bjurlin MA, Rosenkrantz AB, Beltran LS, Raad RA, Taneja SS. Imaging and evaluation of patients with high-risk prostate cancer. Nat Rev Urol 2015; 12:617-28. [PMID: 26481576 DOI: 10.1038/nrurol.2015.242] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Approximately 15% of men with newly diagnosed prostate cancer have high-risk disease. Imaging is critically important for the diagnosis and staging of these patients, and also for the selection of management. While established prostate cancer staging guidelines have increased the appropriate use of imaging, underuse for high-risk prostate cancer remains substantial. Several factors affect the utility of initial diagnostic imaging, including the variable definition of high-risk prostate cancer, variable guideline recommendations, poor accuracy of existing imaging tests, and the difficulty in validating imaging findings. Conventional imaging modalities, including CT and radionuclide bone scan, have been employed for local and metastatic staging, but their performance characteristics have generally been poor. Emerging modalities including multiparametricMRI, positron emission tomography (PET)-CT, and PET-MRI have shown increased diagnostic accuracy and could improve accuracy in staging patients with high-risk prostate cancer.
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Affiliation(s)
- Marc A Bjurlin
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY 10016, USA
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University Langone Medical Center, New York, NY 10016, USA
| | - Luis S Beltran
- Department of Radiology, New York University Langone Medical Center, New York, NY 10016, USA
| | - Roy A Raad
- Department of Radiology, New York University Langone Medical Center, New York, NY 10016, USA
| | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY 10016, USA
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Vicens RA, Rodriguez J, Sheplan L, Mayo C, Mayo L, Jensen C. Brachytherapy in pelvic malignancies: a review for radiologists. ABDOMINAL IMAGING 2015; 40:2645-2659. [PMID: 25820802 DOI: 10.1007/s00261-015-0407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Brachytherapy, also known as sealed source or internal radiation therapy, involves placement of a radioactive source immediately adjacent to or within tumor, thus enabling delivery of a localized high dose of radiation. Compared with external beam radiation which must first pass through non-target tissues, brachytherapy results in less radiation dose to normal tissues. In the past decade, brachytherapy use has markedly increased, thus radiologists are encountering brachytherapy devices and their associated post-treatment changes to increasing degree. This review will present a variety of brachytherapy devices that radiologists may encounter during diagnostic pelvic imaging with a focus on prostate and gynecologic malignancies. The reader will become familiar with the function, correct position, and potential complications of brachytherapy devices in an effort to improve diagnostic reporting and communication with clinicians.
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Affiliation(s)
- Rafael A Vicens
- Department of Radiology, Hospital Auxilio Mutuo, Hato Rey, PR, 00919, USA.
| | - Joshua Rodriguez
- School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Lawrence Sheplan
- Department of Radiation Oncology, Hospital Auxilio Mutuo, Hato Rey, PR, USA
| | - Cody Mayo
- Department of Diagnostic Imaging, University of Virgina, Charlottesville, VA, USA
| | - Lauren Mayo
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Corey Jensen
- Department of Radiology, MD Anderson Cancer Center, Houston, TX, USA
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Prediction of Micrometastasis (< 1 cm) to Pelvic Lymph Nodes in Prostate Cancer: Role of Preoperative MRI. AJR Am J Roentgenol 2015; 205:W328-34. [DOI: 10.2214/ajr.14.14138] [Citation(s) in RCA: 20] [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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